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86 Cards in this Set

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Pectus Excavatum
depression in the lower sternum
Pectus Carinatum
anteriorly displaced sternum
Traumatic Flail chest - def
* multiple rib fractures resulting in paradoxical movements of the thorax.
Flail chest: On inspiration injured area...
caves inward and expiration outward
Thoracic Kyphoscoliosis
abnormal spine curve and vertebral rotation causing chest deformities.
2nd intercostal space is location for
tension pneumothorax needle insertion
4th intercostal space is location for
chest tube insertion
Last rib to articulate with the sternum?
7th
Inferior tip of Scapula lies at the level of?
* 7th rib/interspace.
* T7-T8 interspace is location for thoracentesis
Spinous process of T3 approximates
the location of oblique fissure
The horizontal fissure lies near the
4th rib to midaxillary line near 5th rib
The treachea bifurcates at what level?
sternal angle anteriorly and T4 posteriorly

* aka the corina
The bases of the lung lobes may be approximated at what level?
* 6th rib midclavicular
* 8th rib midaxillary
* T10 spinous process posteriorly
Possible causes of chest pain?
cardiovascular, pulmonary, GI, musculoskeletal, skin, anxiety, and others
Location questions to ask about chest Px?
substernal, shoulder, jaw, neck
Quality questions to ask about chest Px?
pressure, ache, heavy, “crushing”, “ripping or tearing”, sharp
Quantity questions to ask about chest Px?
mild to severe (typically more significant)
1-20 min and intermittent chest px is more typical of?
angina
Constant chest px is more typical of?
pericarditis and dissection
Aggravating chest px to exertion is more typical of?
exertion (angina/MI),
Aggravating chest px to breathing and position is more typical of?
pericarditis
Chest px alleviated to leaning forward is more typical in?
pericarditis
Associated symptoms of chest pain due to MI?
cool, pale and diaphoretic
Levine sign
a clenched fist over the anterior chest typical in coronary syndrome, high specificity
Common causes of chest px due to lung disorder/dysfunction?
1) Tracheobronchitis
2) Pleuritic px
3) bronchospasm
Tracheobronchitis - S/S
* upper chest
* burning, mild-moderate
* aggravated by cough/deep breathing
* alleviated by lying on involved side
Pluritis - S/S
* any chest wall area
* sharp/stabbing, mod-severe, constant
* aggravated by cough/breathing/chest wall motion
Bronchospams - S/S
* substernal
* sharp to ache, mild-severe, episodic
* aggravated by cough/breathing deep
* associated with wheezing/dyspnea
Common causes of chest px due to GI disorder/dysfunction?
1) GERD
2) Esophageal spasm
3) Peptic ulcer
4) Gallbladder
GERD - S/S
* substernal and to back
* burning/squeezing, mild-severe
* worse after meals and lying down
* alleviated with antacids (some)
Esophageal spasm - S/S
* substernal to jaw or back
* squeezing, mild-severe
* aggravated with swallowing
* improved occasionally with belching and antacids
Peptic ulcer - S/S
* substernal to back/abdomen
* ache to burn, mild-severe
* initially may improve with food then worsen later
MSK Chest wall pain - S/S
* any location
* stabbing to ache, mild-severe
* lasts hours to days constant to variable
* aggravated by chest motion, tender over area
Anxiety related chest pain - S/S
* Any chest location
* ache-dull-sharp-pressure, mild-severe
* variable timing usually hours-days
* may follow emotion stress event (but not always)
Congestive heart failure -S/S
* orthopnea
* DOE
* peripheral edema
* cough
* usually gradual onset but could be sudden in flash edema
COPD/Chronic bronchitis - S/S
* cough
* congestion
* DOE
* wheezing
* Decreased Tactile Fremitus
Asthma - S/S
* wheezing
* cough
* prolonged expiration
Interstitial lung disease - S/S
* progressive SOB
* DOE
* weakness
Pneumonia - S/S
* ill
* fever
* cough
* congestion
Pneumothorax - S/S
* MOI
* sudden onset
* pleuritic pain
* often hypoxic
* increasing dyspnea over time
* positional discomfort
* JVD, Trachea deviation, tachycardia
* hyper resonance upon percussion
* Absent breath sounds over lung field
* Decreased Tactile Fremitus
Pulmonary embolism - S/S
* sudden onset
* substernal ache to pleuritic
* risk factors (smokers, heart disease, DVT, clotting disorders)
Anxiety attack - S/S
* tachypnea
* tingling/numbness in hands
* look of panic
respiratory sound heard with inspiration and expiration “accordion sound” -
Wheezing
Wheezing typically signifies what?
airway obstructive from secretions, inflammation, or foreign body
audible high pitched wheezed. Ominous sign of airway obstruction in the larynx or trachea
Stridor
Adventitious lung sound heard in epiglottitis, laryngeal spasm, foreign body
Stridor
coughing up blood from the lungs
Hemoptysis: Always quantify amount and frequency and last episode
Your first concern hemoptysis until proven other wise?
Neoplasm
Causes of hemoptysis?
infection, lung cancer, CHF, PE, irritant
dyspnea that occurs when the patient is lying down and improves with sitting up
Orthopnea - common in CHF
sudden dyspnea and orthopnea that awakens the patient form sleep
Paroxysmal nocturnal dyspnea
deep labored breathing pattern
Kussmal - common DKA
deep breathing alternating with periods of apnea
Cheyne stokes - common in head injuries
How do you test chest expansion anteriorly?
thumbs along costal margin

* Watch the distance between the thumbs during inspiration and feel for symmetry
How do you test chest expansion posterioly?
thumbs at T10

* Watch the distance between the thumbs during inspiration and feel for symmetry
An abnormal findings when examining chest expansion may indicate?
* unilat/bilat fibrosis
* pleural effusion
* lobar pneumonia
* bronchial obstruction
* pneumothorax
palpable vibrations transmitted through the bronchopulmonary tree to the chest wall.
Tactile Fremitus
Decreased Tactile Fremitus: transmission of vibrations from the larynx to chest is impeded, may be caused by?
1) chest wall size
2) obstructed bronchus
3) COPD
4) Pleural effusion
5) fibrosis
6) pneumothorax
7) tumor
Increased Tactile Fremitus may be caused by?
unilateral pneumonia
Pleural Effusion - S/S
* SOB
* flat percussion
* adventitious breath sounds
Dull percussion lung sounds may by a sign of?
* hemothorax
* consolidated pneumonia
* atelectasis
Hyperresinance percussion lung sounds may by a sign of?
* Pneumothorax
* COPD
Normal breath sound:
* soft and low pitched
* usually heard over most of both lungs
Vesicular
Normal breath sound:
* louder and higher in pitch
* usually heard over the manubrium
Bronchial
Normal breath sound:
* intermediate intensity and pitch
* usually heard over the 1st and 2nd interspaces
Bronchovesicular
Normal breath sound:
* very loud, high pitched
* heard over the trachea in the neck
Treacheal
What adventitious breath sounds is brief, intermittent, relatively high pitched sound, “like rubbing hair between two fingers”
Crackles or rales
Crackles/rales may occur in?
pneumonia, fibrosis, early CHF, other
What adventitious breath sounds makes musical sounds, prolonged through respiration, high pitched, with hissing or shrill quality.
Wheezing

* Causes: narrowed airways as in obstructive disease (asthma, COPD)
What adventitious breath sounds makes relatively low pitched, snoring quality, prolonged through respiration
Rhonchi
Secretions in the the upper lungs may cause what breath sound?
Rhonchi
What adventitious breath sounds makes loud, grading or squeaking sound, prolonged.
Friction rub
Friction rub may be diagnostic of what pathology in the lungs?
Pleuritis, pneumonia, PE
What adventitious breath sounds makes an entirely or predominantly inspiratory wheeze, often louder in the neck
Stridor

* laryngeal tracheal obstruction
1) diminished or absent fremitus, tracheal shift toward involved side
2) dullness over area upon percussion
- These physical findings may be caused by
Atelectasis
What findings would be expected with atelectasis upon auscultation
diminished or absent breath sounds, egophony and whispered pectoriloquy
Bronchiectasis - def?
A rare chronic obstructive lung disease characterized by localized and irreversible dilation or widening of part of the bronchial tree
What findings would you except with bronchiectasis?
* Auscultation: crackles usually coarse, rhonchi

* Inspection: tachypnea, respiratory distress, clubbing, cyanosis, wasting
Would you expect increased or decreased fremitus in a COPD pt?
decreased
Would you expect hypo or hyper resonance in a COPD pt?
hyperresonant
What lung sounds are associated with COPD pt's?
crackles, wheezes, and rhonchi associated with bronchitis
What position would aggravate an CHF pt?
exertion, lying flat
What lung pathologies may cause clubbing?
1) Bronchiectasis
2) COPD
3) TB
4) Diffuse Interstitial Lung Disease
Findings expected in a pt with pneumonia
1) Inspection: febrile, distress, labored respiration

2) Palpation: increased fremitus, bronchophony, egophony, and whispered pectoriloquy

3) Percussion: dull over consolidated area

4) Auscultation: bronchial sounds over consolidated area, late inspiratory crackles
Hemoptysis is worrisome with what conditions?
weight loss and cough is lung cancer until proven otherwise
Lung cancer general symptoms?
cough, wheezing, shortness of breath, hemoptysis, DOE, pleurisy, weight loss