Pulm PE

The number of the intercostal space between two ribs is the same as the rib (above/below) it

above

When flexed forward, prominent spinous process is C__?

7

The inferior tip of the scapula is the (#)th rib/intercostal space

7

The apex of the lung runs (above/below) the clavicle

above

Which intercostal space is for needle insertion for decompression of tension pneumothorax?

2nd

Which intercostal space is for chest tube insertion?

4th

Which rib is the lower margin of a well-placed ET tube on CXR?

4th

Which rib is the superior aspect as a landmark for thoracentesis?

8th

Neurovascular structures run along the ____ margin of each rib so needles and tubes should be places just at the ____ rib margins.

inferior;superior

If an ET was placed incorrectly, which lung is it most likely to inflate: left, right, both, neither

right

Inspiration: Intrapulmonary pressure (</>) atmospheric pressure

<

What accessory muscles are involved with (deep) breathing?

SCM, pec minor, scalene, serratus, traps

Expiration: Intrapulmonary pressure (</>) atmospheric pressure

>

Pulmonary arteries carry oxygen (poor/rich) blood

poor

Pulmonary veins carry oxygen (poor/rich) blood

rich

Define ventilation

exchange of air between environment and lungs; includes inspiration and expiration

Define perfusion

Delivery of blood to pulmonary capillaries

Define Diffusion

Gas exchange between alveoli and pulmonary capillaries

What controls breathing: O2 or CO2?

CO2

Which dermatomes mostly cover the neck?

C3-8

Which dermatomes mostly cover the chest?

T1-12

Which dermatome is at nipple level?

T4

Which dermatome is at the belly button?

T10

Define apnea

lack of spontaneous breathing

define dyspnea

difficulty breathing/SOB; requires detailed questioning, cause may be heart/lung disease or other reason

define orthopnea

SOB with lying down, # of pillows required to breath comfortably during sleep

define PND

sudden SOB while sleeping

define platypnea

dyspnea improves with lying down

define cyanosis

bluish discoloration caused by decreased oxygenation

define stridor

audible high pitched whistling - upper airway obstruction

what conditions can cause a dry cough?

GERD, irritant, post viral infection, ILD

what conditions can cause a productive cough?

pneumonia, asthma, bronchitis, PND syndrome, sinusitis

The MCC of a cough is a _____

viral URI

conditions that can cause an acute cough

bronchitis, pneumonia, CHF, asthma, foreign body, smoking, ACE-inhibitor

conditions that can cause a subacute cough

post-infections, pertussis, acid reflux, asthma

conditions that can cause a chronic cough

postnasal drip, asthma, GERD, chronic bronchitis, bronchiectasis

Alarm sx of a cough

hemoptysis, fever + purulent sputum production, wheezing + SOB, chest pain, excessive chronic sputum production, unintentional weight loss, dyspnea, lower extremity weakness

Alarm sx! Cough with hemoptysis can indicate:

lung cancer, TB, PE, pneumonia

Alarm sx! Cough with fever + purulent sputum production can indicate:

pneumonia, lung abscess

Alarm sx! Cough with wheezing and SOB can indicate:

asthma, COPD exacerbation, heart failure

Alarm sx! Cough with chest pain can indicate:

PE, ACS

Alarm sx! Cough with excessive chronic sputum production can indicate:

bronchiectasis, lung abscess, lung cancer

Alarm sx! Cough with unintentional weight loss can indicate:

lung cancer, TB, lung abscess

Alarm sx! Cough with dyspnea, lower extremity edema can indicate:

CHF, PE

Alarm sx of dyspnea

pleuritic CP, lip swelling, hives, wheezing, substernal CP, pink frothy sputum, fever, signs of serious infection/shock, dysphagia, ascending weakness, generalized weakness

CHLORIDE PPAT for hemoptysis is similar to cough, but must add on questions about the ____

blood

Alarm sx for hemoptysis

Quantity: massive (> 1 cup in 24h), submassive (

What are some important personal and social history factors that can lead to pulmonary conditions?

tobacco use, alcohol, drug use, travel, hobbies, employment, home environment, exercise tolerance

in older adults, the chest wall becomes _____

stiffer

in older adults, respiratory muscles _____

weaken

in older adults, gas exchange ability ____

declines

in older adults, coughing is (more/less) effective, increasing risk of pneumonia and atelectasis

less

What can cause tactile fremitus to decrease?

excess air in lungs (effusion or pneumothorax), increase thickness of chest wall

What can cause tactile fremitus to increase?

lung consolidation (air replaced with exudate, blood, pus, etc.)

How would you describe a normal lung sound?

resonant

What conditions would you feel a hyper-resonant lung?

hyperinflated lung, COPD, pneumothorax

What conditions would you feel a dull/flat lung?

fluid filled space: large pleural effusion, pneumonia, solid organ, muscle (solids)

what conditions would you feel tympany?

large pneumothorax, normal stomach (air filled)

vesicular, bronchovesicular, bronchial, tracheal are all (normal/abnormal) breath sounds

normal

Vesicular breath sounds

low pitch, heard over most lungs. Soft and short expiration

bronchovesicular breath sounds

medium pitch, heard over main bronchus area. Inspiration = Expiration

bronchial breath sounds

high pitched, loud/harsh and long expirations

tracheal breath sounds

loud, harsh; heard only over trachea

crackles (rales), rhonchi, wheeze, stridor, friction rub are all (normal/abnormal) breath sounds

abnormal

Crackles (rales)

discontinuous, discrete sounds, most often heard during inspiration, caused by disrupted airflow in smaller airways -- NOT usually cleared by cough

Rhonchi

deeper, rumbling, sounds like "snore" caused by obstruction/secretion in larger airways. Often clears with cough

Wheeze

High pitched, continuous, caused by high velocity airflow through narrowed/obstructed airways

stridor

high pitched, piercing, most often heard during inspiration (often from tracheal obstruction)

friction rub

grating, sandpaper-like, machine-like; inspiration and expiration from roughened surfaces

What is the difference between a cardiac and pleural friction rub?

You can still hear a cardiac friction rub if the patient holds their breath

Cheyne-Stokes breathing

periods of deep breathing alternating with periods of apnea (no breathing)

Ataxic Breathing (Biot's Breathing)

Irregular breathing -- alternating periods of apnea and regular deep breaths

Sighing Respiration

Breathing punctuated by frequent sighs - suggests hyperventilation syndrome—a common cause of dyspnea and dizziness. Occasional sighs are normal

Obstructive breathing

expiration is prolonged because of narrowed airways

What are transmitted voice sounds useful for?

hearing areas of consolidation

If consolidation is present doing egophony, "e" will sound like

a

If consolidation is present doing whispered pectoriloquy, "123" will sound

louder

If consolidation is present doing bronchophony, "99" will sound

louder

what conditions might you find barrel chest in?

arthritis, COPD, asthma

Flair chest can indicate

multiple rib fractures

subjective asthma sx

PND, nocturnal sx, chest pain/tightness, may last minutes-days

When inspecting asthma, you may find:

tachypnea, nasal flaring, retractions

When palpating asthma, you may find:

tachycardia, diminished fremitus

When percussing asthma, you may find:

occasional hyperresonance, occasional limited diaphragmatic descent

When auscultating asthma, you may find:

prolong expiration, wheezes, possible crackles, diminished lung sounds

subjective acute bronchitis sx

cough, fever, CP -- burning retrosternal discomfort

When inspecting acute bronchitis, you may find:

occasional tachypnea; often normal

When palpating acute bronchitis, you may find:

tactile fremitus unchanged

When percussing acute bronchitis, you may find:

resonance

When auscultating acute bronchitis, you may find:

occasionally prolonged breath sounds, crackles, expiratory wheezes, and rhonchi

prominent COPD sx

cough, chronic excessive sputum, dyspnea

When inspecting emphysema, you may find:

tachypnea, deep breathing, pursed lips, barrel chest, thin, underweight, tripod, clubbing

When palpating emphysema, you may find:

decrease fremitus and decreased chest expansion

When percussing emphysema, you may find:

hyperresonance

When auscultating emphysema, you may find:

decreased breath sounds, prolonged expiration, wheezing

When inspecting chronic bronchitis, you may find:

cyanosis, clubbing, JVP in advance disease

When palpating chronic bronchitis, you may find:

normal/ decreased fremitus, normal/decreased chest expansion

When percussing chronic bronchitis, you may find:

resonant

When auscultating chronic bronchitis, you may find:

decreased breath sounds, prolonged expiration, diffuse rhonchi, crackles and wheezing due to bronchospasm

When inspecting bronchiectasis, you may find:

tachypnea, clubbing, resp distress