Thorax&lungsch18N400Physicalassessmentabnormalfindingsfsmfn

Front 1

Define Atelectasis (Collapse)

Back 1

Collapsed shrunken section of alveoli, or an entire lung, as a result of:
1.) Airway obsturction (e.g. the bronchus is completely blocked by thick exudate, aspirated foreign body, or tumor), the alveolar air beyond it is gradually absorbed by the pulmonary capillaries, and the alveolar walls cave in.
2.) Compression on the lung
3.) Lack of surfactant (hyaline membrane disease)

Front 2

Define Lobar pneumonia

Back 2

Infection in lung parenchyma leaves alveolar membrane edematous and porous, so RBC's and WBC's pass from blood to alveoli. Alveoli progressively fill up (become consolidated) with bacteria, solid cellular debris, fluid, blood cells, all of which replace alveolar air. This resulst is decreased surface area of the respiratory memebrane, which causes hypoxemia

Front 3

Define Bronchitis

Back 3

Proliferation of mucus glands in the passage ways, resulting in excessive mucus secretion. Inflammation of bronchi with partial obstruction of bronchi by secretions of constrictions. Section of lung distal to obstruction may be deflated. Bronchitis may be acute or chronic with recurrent productive cough. Chronic bronchitis is usually cause by cigarette smoke.

Front 4

Define Emphysema

Back 4

Caused by destruction of pulmonary connective tissue (elastin & collagen)

Front 5

Define Hemoptysis

Back 5

Frank blood in sputum

Front 6

Name the conditions we see unequal chest expansion in:

Back 6

Atelectasis
pneumonia
thoracic trauma
pnuemothorax

Front 7

What conditions have hyperresonance as a percussion finding?

Back 7

Emphysema
pneumon thorax

**Normal in infants and children**

Front 8

What condtions have a dull sound as a percussion finding?

Back 8

pneumonia
pleural effusion
atelectasis
tumor

Front 9

Name the types of adventitious breathe sounds

Back 9

Crackles (rales)
Wheezes (rhonci)

Front 10

Define Barrel Chest

Back 10

Note equal anterior-to-transverse diamete and that ribs are horizontal instead of the normal downward slope. This is associated with normal aging and also with chronic emphysema and asthma as a result of hyperinflation of lungs

Front 11

Define Pectus Excavatum

Back 11

A markedly sunken sternum and adjacent carliages (AKA funnel breast). Depression begins at 2nd ICS, becoming depressed most at the junction of xiphoid with body of sternum. More noticeable on inspiration. Congenital, usually not symptomatic. When severe, sternal depression may cause embarrasemenet and negative self-image. Surgery may be indicated.

Front 12

Define Pectus Carinatum

Back 12

A forward protrusion of the sternum, with ribs sloping back at either side and vertical depressions along constochondral junctions (AKA pigeon breast). Less common than pectus excavatum, this minor deformity requires no treatment. If severe, surgery may be indicated.

Front 13

Define Increased Tactile Fremitus

Back 13

Occurs with conditions that increase the density of lung tissue) thereby making a better conducting medium for vibrations. There must be a patent bronchus, and consolidation must extend to lung surface for increased fremitus to be present

Front 14

Define Decreased Tactile Fremitius

Back 14

Occurs with anything that obstructs transmission of vibration (ex. obstructed bronchus, pleural effusion, thickening pneumothorax, & emphysema) Any barrier that gets in the way of the sound and your palpating hand decreases fremitius.

Front 15

Define Bronchophony

Back 15

Ask the person to repeat 99, while you listen with the stethescope over the chest wall; listen expecially if you suspect pathology.

Front 16

Normal finding in Bronchophony?

Back 16

Normal voice transmission is soft, muffled, and indistinct; you can hear sound through the stethoscope, but cannot distinguish exactly what is being said.

Front 17

Abnormal finding in Bronchophony?

Back 17

Pathology increases lung density will enhance transmission of voice sounds/ you auscultate a clear 99. The words are more distinct than normal and sound close to your ear.

Front 18

Define Egophony

Back 18

Greek: "Voice of the goat", Auscultate the chest while the person phonates a long "ee-ee-ee-ee" sound

Front 19

Normal Finding in Egophony?

Back 19

The normal response if faint, muffled, and almost inaudible

Front 20

Define Bronchophony

Back 20

Ask the person to repeat 99, while you listen with the stethescope over the chest wall; listen expecially if you suspect pathology.

Front 21

Normal finding in Bronchophony?

Back 21

Normal voice transmission is soft, muffled, and indistinct; you can hear sound through the stethoscope, but cannot distinguish exactly what is being said.

Front 22

Abnormal finding in Bronchophony?

Back 22

Pathology increases lung density will enhance transmission of voice sounds/ you auscultate a clear 99. The words are more distinct than normal and sound close to your ear.

Front 23

Define Egophony

Back 23

Greek: "Voice of the goat", Auscultate the chest while the person phonates a long "ee-ee-ee-ee" sound

Front 24

Normal Finding in Egophony?

Back 24

The normal response if faint, muffled, and almost inaudible

Front 25

Abnormal finding in Egophony?

Back 25

Over area of consolidation or compression, the spoken 'eeee' sound changes to a bleating long "aaaaa' sound.

Front 26

Inspection Findings in relation to Atelectasis:

Back 26

Cough
Lag on expansion of affected side.
Increase respiratory rate & pulse.
Possible Cyanosis

Front 27

Palpation Findings in relation to Atelectasis:

Back 27

Chest expansion decreased on affected side.
Tactile fremitus decreased or absent over area.
With large collapse, tracheal shift toward affected side.

Front 28

Percussion Findings in relation to Atelectasis:

Back 28

Dull over area (remainder of thorax sometimes may have hyperressonance note)

Front 29

Auscultation Findings in realtion to Atelectasis:

Back 29

Breath sounds decreased vesicular or absent over area.
Voice sound variable, usually decrease or absent over affected areas.

Front 30

Adventitious Breathe Sounds in relation to Atelectasis:

Back 30

None if bronchus is obstructed. Occasional fine crackles if bronchus is patent.

Front 31

Inspection findings in relation to Lobar Pneumonia:

Back 31

Increased repiratory rate.
Guarding and lag on expansion of affected side
Children-sternal retractions & nasal flaring

Front 32

Palpation findings in relation to Lobar pneumonia:

Back 32

Chest expansion decreased on affected side. Tactile fremitus increased if bronchus patent, decreased if bronchus obstructed.

Front 33

Auscultation finding in relation to Lobar pneumonia:

Back 33

Breath sounds lounder with patent bronchus, as if coming directly from larynx. Voice sounds have increased clarity, bronchophony, egophony, whispered pectorioquy present.
Children-diminished breath sounds my occur early in pneumonia.

Front 34

Adventitious breathe sounds in relation to lobar pneumonia:

Back 34

Crackles, fine to medium.

Front 35

Inspection Findings in realtion to Bronchitis:

Back 35

Hacking, rasping cough productive of thick mucoid sputum. Chronic-dyspnea, fatigue, cyanosis, possible clubbing of fingernails

Front 36

Palpation findings in relation to Bronchitis:

Back 36

Tactile fremitus

Front 37

Percusssion findings in relation to Bronchitis:

Back 37

Resonant

Front 38

Auscultation findings in realtion to Bronchitis:

Back 38

Normal vesicular. Voice sounds normal.
Chronic-prolonged expiration

Front 39

Adventitious breathe sounds in relation to Bronchitis:

Back 39

Crackles over deflated areas. May have wheeze.

Front 40

Inspection findings in relation to Emphysema:

Back 40

Increased AP diameter. Barrel chest. Use of accessory muscles to aid respiration. Tripod position. SOB, especially on exertion. Respiratory distress. Tachypnea

Front 41

Palpation findings in realtion to Emphysema:

Back 41

Decreased tactile fremitus and chest expansion

Front 42

Percussion findings in realtion to Emphysema

Back 42

Hyperresonance. Decreased diaphragmatic excursion.

Front 43

Auscultation findings in realiton to Emphysema:

Back 43

Decreased breathe sounds
May have prolonged expiration
Muffled heart sounds resulting from overdistened lungs.

Front 44

Adventitious breathe sounds in relation to Emphysema:

Back 44

Usually none; occasionally, wheezes

Front 45

Define Asthma (Reactive Airway disease)

Back 45

An allergic hypersensitivity to certain allergens (pollen), irritants (tobacco, ozone), microrganisms, stress, or exercise that produces a complex response characterized by bronchospasm, and inflammation, edema in walls of bronchioles, and secreation of highley viscous mucus into airways. These factors greatly increase airway resistance, especially during expiration, and produce the sysmptoms of wheezing, dyspnea, and chest tightness.

Front 46

Inspection findings in relation to Asthma:

Back 46

During severe attach: increased repiratory rate, SOB w/ audible wheeze, use of accessory muscles, cyanosis, apprehension, retraction of ICS. Expiration labored prolonged. When chronica may have barrel chest.

Front 47

Palpation findings in relation to Asthma:

Back 47

Tactile fremitus decreased, tachycardia

Front 48

Percussion findings in relation to Asthma:

Back 48

Resonant. May be hyperessonant if chronic

Front 49

Ausculatation findings in relation to Asthma:

Back 49

Diminished air movement. Breathe sounds decreased, with prolonged expiration. Voice sound decreased.

Front 50

Adventitious breathe sounds in realtion to Asthma:

Back 50

Bilateral wheezing on expiration, sometime inspiratory and expiratory wheezing.

Front 51

Define Pleural Effusion (Fluid) or thickening:

Back 51

Collection of excess fluid in the intrapleural space, with compression of overlying lung tissue. Effusion may contain watery capillary fluid (transductive), proteint (exudative) purulent matter (empyemic), blood (hemothorax), or milky lymphatic fluid (chylothorax). Gravity settles fluide in dependent areas of thorax. Presence of fluid subdues all long sounds.

Front 52

Inspection findings in relation to Pleural Effusion:

Back 52

Increased respirations, dyspnea; may have dry cough, tachycardia, cyanosis, ABD distention.

Front 53

Palpation findings in relation to Pleural Effusion:

Back 53

Tactile fremitus decreased or absent. Tracheal shift away from affected side. Chest expansion decreased on affected side.

Front 54

Auscultation findings in relation to Pleural Effusion:

Back 54

Breathe sounds decreased or absent. Voice sounds decreased or absent. When remainder of lung is compressed near the effusion, may have bronchial breath sounds over the compression along with bronchophony, egophony, whispered pectiloquy.

Front 55

Adventitious breathe sounds in relation to Pleural Effusion:

Back 55

None

Front 56

Define Heart Failure in relation to the respiratory system:

Back 56

Pump failure with increasing pressure of cardiac overload causus pulmonary congestion or an increased amount of blood present in pulmonary capillaries. Dependent air sacs are deflated. Pulmonary capillaries engorged. Bronchial mucosa may be swollen.

Front 57

Inspection findings in relation to Heart failure

Back 57

Increase respiratory rate
SOB on exertion
Orthopnea
PND
Nocturia
Ankle edema
Pallor in light skinned people

Front 58

Palpation findings in relation to heart failure:

Back 58

Skin moist, clammy
Tactile fremitus, normal

Front 59

Percussion findings in relation to heart failure:

Back 59

Resonanat

Front 60

Ausculation findings in relation to Heart Failure:

Back 60

Normal vesicular.
Heart sounds include S3 gallop