Thorax & Lungs

Front 1

At what level does the trachea bifurcate into the main bronchi?

Back 1

Sternal angle/ T4

Front 2

What are important components of the respirator/ thorax inspection?

Back 2

rate, rhythm, symmetry, trauma, tracheal deviation

Front 3

The anterior/posterior diameter should be about ____ the transverse diameter.

Back 3

1/2

Front 4

What is kyphosis?

Back 4

excessive curvature of the spine

Front 5

What is scoliosis?

Back 5

Abnormal lateral curvature of the spine

Front 6

The 2nd intercostal space is a landmark for ___. The 4th is a landmark for ___, and T4 is a landmark for ____.

Back 6

2nd space = needle decompression,
4th space = chest tube insertion
T4 = lower margine of ETT on CXR

Front 7

What is the landmark for a thoacentesis?

Back 7

T7-8

Front 8

The apex of each lung rises approximately ____ above the inner third of the clavicle.

Back 8

2-4cm

Front 9

THe lower border of the lung is at the _____ midclavicular and ____ midaxillary

Back 9

1. 6th rib midclavicular,
2. 8th rib midaxillary

Front 10

Posteriorly, the lower border of the lung lies about the level of ____.

Back 10

T10

Front 11

A clenched fist over the sternum suggests ___.

Back 11

Angina pectoris

Front 12

A pointing finger to a tender area on the chest wall suggests ____

Back 12

musculoskeletal pain

Front 13

A hand moving from neck to epigastrum suggests ___

Back 13

heartburn

Front 14

What is the most frequent cause of chest pain in children?

Back 14

Anxiety

Front 15

What is a paresthesia?

Back 15

sensation of tingling or pins andneedes, especially around the lips or extremities.

Front 16

Episodic dyspnea during rest and exercis, and hyperventilation may indicate

Back 16

anxiety

Front 17

___ suggests partial airway obstruction form secretions, tissue inflammation, or foreign body.

Back 17

Wheezing

Front 18

What is the most common cause of acute cough?

Back 18

viral upper respiratory infections

Front 19

subacute cough can indicate what?

Back 19

post-infections cough, bacterial sinusitis, or asthma

Front 20

Some diseases that may present with chronic cough include:

Back 20

postnasal drip, asthma, GERD, chronic bronchitis, bronchiectasis

Front 21

What is mucoid sputum?

Back 21

translucent, white, or grey

Front 22

What is purulent sputum?

Back 22

yellowish or greenish

Front 23

Foul-smelling sputum could suggest what?

Back 23

anaerobic lung abscess

Front 24

tenacious sputum is common in what?

Back 24

cystic fibrosis

Front 25

What is hemoptysis?

Back 25

coughing blood from the lungs

Front 26

What is the leading preventable cause of death?

Back 26

Smoking

Front 27

audible stridor suggests ___

Back 27

airway obstruction in the laryns or trachea

Front 28

Lateral displacement of the trachea could indicate what?

Back 28

pneumothorax, pleural effusion, atelectasis

Front 29

What are some diseases that may present with retractions?

Back 29

severe asthma, COPD, or upper airway obstruction

Front 30

What does unilateral impairment or lagging of respiratory movement suggest what?

Back 30

Disease of the underlying lung or pleura such as fibrosis, pleural effusion, pneumonia

Front 31

What are sinus tracts?

Back 31

blind, inflammatory, tubelike structures that open onto the skin.

Front 32

What do sinus tracts indicate?

Back 32

Infection of underlying pleura and lung as in TB

Front 33

What is tactile fremitus?

Back 33

palpable vibrations transmitted through bronchopulmonary tree to chest wall with speaking.

Front 34

What are causes of decreased tactile fremitus?

Back 34

Thick chest wall, obstructed bronchus, COPD, pleural effusion, fibrosis, pneumothorax, or tumor

Front 35

What is one cause of increased tactile fremitus?

Back 35

pneumonia

Front 36

When percussing an area with a large pleural effusion, you would expect it to sound how?

Back 36

Flat

Front 37

When percussing and area with and underlying pneumonia, you would expect it to sound how?

Back 37

dull

Front 38

If you hear hyperresonnance or tympany on percussion, you should consider what disease processes?

Back 38

COPD, pneumothorax

Front 39

There are ___ places to auscultate in the posterior thorax and ___ in the anterior thorax.

Back 39

14 posterior, 12 anterior

Front 40

THe normal diaphragmatic excursion should be ___.

Back 40

5-6cm

Front 41

A high diaphragm level suggests ____, ___, or ___.

Back 41

pleural effusion, atelectasis, or diaphragmatic paralysis

Front 42

Bronchovesicular or bronchial breath sounds heard far from the upper chest or manubrium may suggest what?

Back 42

air-filled lung has been replaced by fluid-filled or solid lung tissue

Front 43

Where are vesicular lung sounds typically heard?

Back 43

The large part of both lungs

Front 44

Where are bronchovesicular sounds usually heard?

Back 44

1st and 2nd interspaces anteriorly and between scapula

Front 45

Where are bronchial sounds usually heard?

Back 45

Over the manubrium if at all

Front 46

Where are tracheal sounds heard?

Back 46

Over trachea and neck

Front 47

A short gap of silence between inspiratory and expiratory sounds suggests ___

Back 47

bronchial lung sounds

Front 48

What are adventitious lung sounds?

Back 48

added, non-normal lung sounds superimposed on normal ones.

Front 49

Fine, late inspiratory crackles that persist from breath to breath suggest ____

Back 49

abnormal lung tissue

Front 50

What is the difference between fine and coarse crackles?

Back 50

fine: soft, high-pitched, very brief (5-10msec)
coarse: louder, lower in pitch and brief (20-30msec)

Front 51

What does wheezing suggest?

Back 51

narrowed airways as in asthma, COPD, or bronchitis

Front 52

What does rhonchi suggst?

Back 52

secretions in large airways

Front 53

What are findings considered to be predictive of COPD?

Back 53

wheezing, hx of smoking, age, and decreased breath sounds

Front 54

Diagnosis of COPD requires what?

Back 54

pulmonary function tests such as spirometry

Front 55

Increased transmission of voice sounds (bronchophony or egophony) suggests?

Back 55

air-filled lung has become air-less

Front 56

When "ee" to "aa" change is present in egophony, it suggests __/

Back 56

lobar consolidation as in pneumonia

Front 57

On palpating the chest, tender pectoral muscles or costal cartilages suggest (but do NOT prove) ___/

Back 57

the chest pain is likely of musculoskeletal origin

Front 58

Patients older than 60 with a forced expiratory time of ____ are twice as likely to have COPD.

Back 58

6-8 seconds

Front 59

Describe the presentation of pectus excavatum.

Back 59

depression in lower portion of the sternum, may result in compression of heart and great vessels with murmurs

Front 60

Describe barrel chest

Back 60

increased AP diameter. Normal shape during infancy, but accompanies aging and COPD

Front 61

Describe pectus corinatum.

Back 61

"pigeon chest", sternum displaced anteriorly, increasing AP diameter. Costal cartilages adjacent to the protruding sternum are depressed

Front 62

Describe flail chest

Back 62

multiple rib fractures may result in paradoxical movements of the thorax.

Front 63

Describe thoracic kyphoscoliosis.

Back 63

Abnormal spinal curvatures and vertebral rotation deform the chest. May distort the underlying lungs.

Front 64

What does persistent localized wheezing suggest?

Back 64

partial obstruction of a bronchus by a tumor or foreign body

Front 65

Inflammed and roughened surfaces grate against each other, delayed by increased friction making a sound called ___

Back 65

pleural rub

Front 66

What is a mediastinal crunch?

Back 66

Series of precordial crackles synchronous with the heart beat and NOT with respiration. It is best heard in L lateral position due to mediastinal emphysema

Front 67

Another name for mediastinal crunch is what?

Back 67

Hamman's sign

Front 68

Name the disorder: productive cough present, resonant to percussion, trachea midline, vesicular lung sounds, mild or no adventitious sounds, normal tactile fremitus,

Back 68

chronic bronchitis

Front 69

Name the disorder: resonance to percussion, trachea midline, vesicular lung sounds, late inspiratory crackles, possible wheezing, normal tactile fremitus,

Back 69

Early heart failure (L side)

Front 70

Name the most likely disease: dull to percussion, trachea midline, bronchial sounds over affected area, late inspiratory crackles, increased fremitus with brochophony, egophony and WP.

Back 70

Consolidation

Front 71

Name the most likely disorder: dull to percussion, trachea may be midline or shifted toward involved lung, lugn sounds may be absent in affected area without adventitious sounds, fremitus usually absent

Back 71

Atelectasis

Front 72

Name the most likely condition: dull to flat percussion, trachea shifted toward opposide side, breath sounds decreased or absent with some bronchial sounds, possibly a pleural rub, decreased or absent fremitus

Back 72

Pleural effusion

Front 73

Name the most likely disorder: hyerresonant or tympanic, trachea shifted to opposite side, decreased or absent lung sounds, possible pleural rub, no fremitus

Back 73

Pneumothorax

Front 74

Name the most likely disorder: diffusely hyperresonant, trachea midline, decreased or absent lung sounds, may have wheezing, crackles, or rhonchi, decreased tactile fremitus

Back 74

COPD

Front 75

Name the most likely disorder: resonant or hyperresonant to percussion, trachea midline, wheezing with possible crackles, absent in severe cases, decreased fremitus

Back 75

Asthma

Front 76

Name the most likely disorder: sudden onset of dyspnea, no relief, may have pinpoint or pleuritic pain, cough, and hemoptysis and may have symptoms of anxiety

Back 76

pulmonary embolus

Front 77

What are risk factors of pulmonary embolus?

Back 77

postpartum or postoperative, prolonged bedrest, CHF, leg or hip fractures, hx or current DVT

Front 78

Describe pain associated with angina pectoris

Back 78

retrosternal or anterior chest pain that may radiate, pressing/squeezing/heavy, mild to moderate, lasts upt o 10-20 mins, relieved with rest or nitroglycerine, worse with exertion, meals, or stress, may also have dyspnea or sweating

Front 79

How can you differentiate between MI or angina?

Back 79

MI pain is often but not always severe, may last 20minutes or longer, nothing relieves pain

Front 80

Describe the pain of a dissecting aortic aneurysm.

Back 80

anterior pain radiating ot neck back or abdomen, described as "ripping" or "tearing", pain is very severe with abrupt onset and persistent for hours or more. pain worsened with hypertension,