Assessment Final - Chest

Front 1

How many pairs of ribs are there

Back 1

12

Front 2

What anatomic landmark is the lower boundary of the thorax

Back 2

diaphragm

Front 3

lung lobes on L side vs R side

Back 3

2 on left; 3 on R

"Fluid in the fissure --> seen between 1st and 2nd lobe of R lung"

Front 4

CXR findings for TTN

Back 4

= streaky perihilar linear densities (perihilar --> anchors to heart with vessels)

Perihilar streaking correlates with the engorgement of the lymphatic system with retained lung fluid, and fluid in the fissures

Front 5

Spinal vertebrae (areas and how many vertebrae are in each area)

Back 5

7 Cervical

12 Thoracic

5 Lumbar

5 Sacral

4 Coccygeal

--> Tip to remember: Eating times. 7 am breakfast, 12 pm lunch, 5 pm dinner.

"Cool Things Like Spinal Column"

Front 6

Chest references lines (6)

Back 6

Midsternal line

Nipple line (across, not vertical)

Midclavicular line

Anterior axillary line

Midaxillary line

Posterior axillary line

Front 7

What "sign" do you see with pneumomediastinum?

Back 7

Sail sign - lifts flap of thymus up

Cross lateral xray will show air under sternum

--> can go to neck (subq emphysema), esophagus (pneumoperitoneum), pneumopericardium (EMERGENCY!) & other places

Front 8

Where do you needle decompress for a pneumothorax

Back 8

2nd ICS (unless placing a chest tube, then 4th ICS)

Front 9

PDA "diastolic steal" occurs how? and what does it affect?

Back 9

Blood (typically) flows back to lungs with increasing blood in L atrium (up to 80% can go back to lungs). L-->R shunt once PVR decreases

Diastolic steal decreases blood flow to organs (kidneys - low UOP, etc)

Front 10

Pectus carinatum vs pectus excavatum

Back 10

carinatum - "pigeon chest" (outward)

excavatum - "tunnel chest," (inward) may make baby look like they are having increased retractions

Or may have prominent xyphoid process

Front 11

What does barrel chest mean? When do you see it?

Back 11

Increased AP diameter, hyperinflation (will hear decreased lung sounds)

TTN, MAS (alveoli don't close bc sticky --> increased diameter)

Increased CO2, Turn down pressure bc baby cant exhale = overexpanded

Front 12

Primary respiratory muscle

Back 12

diaphragm

Front 13

periodic breathing

Back 13

irregular cycle, but normal

cessation of breathing up to 5-20 seconds

followed by rate of 50-60 bpm

termed "Cheyne Stokes in kids and adults"

Front 14

apnea

Back 14

cessation of breathing > 20 seconds or cessation of breathing < 20 seconds with bradycardia and cyanosis

At least 25% of preemies

Inverse relationship with GA

Front 15

Why does nasal flaring help a baby in respiratory distress?

Back 15

Decreases airway resistance, increases minute ventilation

Front 16

Why does grunting help a baby in respiratory distress?

Back 16

Partially closed glottic increases intrathoracic pressure preventing alveolar collapse (increased FRC)

Front 17

Types of retractions (and why we see them)

Back 17

Suprasternal

Intercostal

Subcostal

Substernal

Thin chest wall and decreased lung compliance

Front 18

Suprasternal retractions with gasping or stridor may indicate _________

Back 18

upper airway obsruction

Front 19

paradoxical breathing - what is it and why do we see it

Back 19

"see saw" breathing

decreased lung compliance & indication of respiratory distress

Front 20

head bobbing is a sign of ______

Back 20

mild - severe labored breathing

Front 21

Snoring/snorting is a sign of _______

Back 21

nasal congestion

Front 22

How do babies lung sounds differ from adults

Back 22

Louder and coarser than adults due to less subcutaneous fat

Sounds are easily referred

Front 23

Reasons lung sounds may be diminished

Back 23

Pleural space contains fluid

Bronchus contains secretions

Lungs hyperinflated

Front 24

Lower lobes can only be assessed from where

Back 24

the back

Front 25

Best lung auscultation technique

Back 25

diaphragm, start at top and move systematically from side to side

Front 26

Neonates usually have ______ pitched sounds; intensity between inspiration and expiration is ______

Back 26

higher pitched sounds

Intensity is similar between inspiration and expiration

Front 27

Bronchial breath sounds

Back 27

LOUDEST, heard at trachea

short inspiration, longer expiration

Front 28

Bronchovesicular

Back 28

inspiration = expiration in terms of pitch, intensity, quality

Heard best @ 1st and 2nd ICS

heard over manubrium and intrascapular areas

Front 29

Vesicular

Back 29

soft, short, low pitched during expiration, louder, longer, higher pitched during inspiration

heard all over chest except trachea and manubrium

Front 30

Crackles (3 types)

Back 30

crackling or bubbling sound

Fine - rubbing lock of hair (dependent lobes of lung, in alveoli, @ end of inspiration. A/C RDS & BPD)

Medium - fizz or carbonated drink (bronchioles, A/C air through sticky surfaces, ie pneumonia, pulm congestion, TTN)

Coarse - loud and bubbly, lower pitch, higher amplitude, long duration (significant accumulation of mucus or fluid in large airways)

Front 31

Rhonci

Back 31

lower pitched from wheezes, more musical than crackles

*rare in neonates

Front 32

Wheezes

Back 32

"high pitched rhonci," heard on both inspiration and expiration (louder on expiration)

seldom heard in infants other than with BPD

homophonus - uniform

heterophonus - not uniform

Front 33

Rubs

Back 33

hold cupped hand to ear and rub finger over it

-inflammation of pleura

-on mechanical ventilators

Front 34

Stridor

Back 34

high-pitched, hoarse sounds

heard on inspiration and expiration but usually louder on inspiration

at larynx or upper airway

partial obstruction or post extubation

*may have tracheomalacia, reposition baby

Front 35

bowel sounds heard in lung fields?

Back 35

May be referred BUT also think about CDH - usually presents on L side with CDH with scaphoid abdomen

Front 36

Where do you listen for air leaks in intubated babies?

Back 36

Over mouth or trachea

Front 37

Palpate clavicles& sternum / ribs for ____

Back 37

Clavicles for fracture

Sternum & ribs for crepitus or masses

Front 38

Costal cartilage - check for ______

Back 38

hypertrophy or "rachitic roasary" (rickets)

Front 39

Fremitus

Back 39

palpable vibration on chest wall

air passing through fluid-filled tubes

water hammer effect (intubated)

Front 40

Normal size breast bud

Back 40

Full term - 0.5 - 1 cm, areola raised and stippled

Hypertrophied? d/t maternal estrogen

Front 41

What do you look for out of the ordinary regarding nipples?

Back 41

Fissures, hypertrophy, witch's milk (pseudo lactation), supernumerary/accessory nipples, mastitis

Front 42

Internipple distance should be ______

Back 42

< 1/4 chest circumference

Front 43

S/S of Turner's syndrome

Back 43

(missing a sex chromosome)

Short

Failure to begin puberty

Infertility

Heart defects
Learning disabilities

Wide spaced nipples