5 Pulmonary System Flashcards

Flashcards covering key concepts from the pulmonary system lecture notes.

List anatomical bony structures used as landmarks on the chest.

Sternum, Suprasternal notch, Sternal angle, 2nd rib, 2nd rib interspace, Costal angle, Costochondral junction, Xyphoid process

Which ribs are attached to the sternum?

1-7

Which ribs are attached to each other?

8-10

Which ribs are hanging free?

11-12

How do you count intercostal spaces in the thorax?

Start from rib #2 (opposite the sternal angle) and "walk down" the interspaces.

Which is the most prominent spinous process in the neck?

C7

Where does the tip of the scapula usually cover posteriorly?

The 7th rib

Name the vertical lines used to describe the circumference of the chest.

Midsternal line, Midclavicular line, Anterior axillary line, Midaxillary line, Posterior axillary line, Vertebral line, Scapular line

Define suprasclavicular

Above the clavicles

Define 'infraclavicular'

Below the clavicles

Define 'interscapular'

Between the scapulae

Define 'Infrascapular'

Below the scapulae

Where does the apex of each lung rise anteriorly?

On the upper border approximately 2 to 4 cm above the inner third of the clavicle

Where is the lower border of the lung located on the midclavicular line?

Rib 6

Where is the lower border of the lung located on the midaxillary line?

Rib 8

How is the right lung divided?

Upper, middle, and lower lobes (RUL, RML, and RLL)

How is the left lung divided?

Upper and lower lobes (LUL, LLL)

Where can breath sounds in the trachea and main bronchus be heard?

Above the sternal angle in the anterior thorax and between the scapulae in the posterior thorax.

What are the stages of the physical examination?

Inspection, palpation, percussion, auscultation

What should you observe during inspection?

Breathing (rate, depth, regularity), signs of respiratory distress, additional signs (trachea location, clubbing), chest shape and expansion.

What is the normal thorax shape in adults?

Wider than it is deep; lateral diameter is larger than the anteroposterior diameter.

What is a barrel chest?

An increased anteroposterior diameter, normal during infancy, and often accompanies normal aging and chronic obstructive pulmonary disease.

What is a traumatic flail chest?

If multiple ribs are fractured, paradoxical movements of the thorax may be seen. Descent of the diaphragm decreases intrathoracic pressure. On inspiration the injured area caves inward. On expiration it moves outward.

What is a funnel chest (Pectus Excavatum)?

A depression in the lower portion of the sternum. Compression of the heart and great vessels may cause murmurs.

What is pigeon chest (pectus carinatum)?

Stan is displaced Anteriorly. Increasing the anti-posterior diameter Coastal cartilage adjacent to the protruding sternum are depressed.

What is thoracic kyphoscoliosis?

Abnormal spinal curvature and vertebral rotation deform the chest. Distortion of the underlying lungs may interpretation of lung findings very difficult

What position should the patient be in during a chest examination?

Sitting or standing

What should you evaluate during palpation?

Tender areas, lumps or skin findings, chest expansion, and fremitus.

What is fremitus?

Palpable vibrations transmitted through the bronchopulmonary tree to the chest wall as the patient is speaking; normally symmetric.

How is fremitus assessed?

With the ball or ulnar side of the palm. Ask the patient to say 99 in a deep and strong voice. Move along the lung outline.

How do you assess the degree of the chest expansion and symmetry?

Place your hands at the level of the 10th rib. Move your hands slightly medially to create a skin fold. Ask the subject to breathe deeply and see the thumbs move away.

What is the purpose of percussion?

To differentiate between tissue filled with air and tissue filled with liquid or solid tissue.

Name possible percussion sounds

Flatness, Dullness, Resonance, Hyperresonance, Tympany

What are the signs of flatness sound in percussion?

It’s very dull, Soft intensity, high pitch, found in the thigh. Example would be large plural effusion.

What are the signs of dullness sound in percussion?

Dull sound, medium intensity, medium pitch, could be located by the liver. Example would be pneumonia.

What are the signs of resonance sound in percussion?

The sound is resonant it’s loud. The picture is low. An example of the location would be a normal lung or bronchitis.

What are the signs of hyperresonance sound in percussion?

The sound is hyper resonant. It’s very loud the pitch is lower. Example Emphysema.

What are the signs of tympany sound in percussion?

The sound is drum like. It’s loud. The pitch is high. An example location is inflated cheek. Example pathology pneumothorax.

What can be detected when percussion is performed?

Paralysis of the diaphragm or collapsed a lung.

What is determined when auscultation is performed?

Height of the diaphragms and their mobility.

Which part of the stethoscope should be used for auscultation, and on what?

Listen with the diaphragm of the stethoscope directly on the skin.

What normal breath sounds exist?

Vesicular, Bronchovesicular, Bronichal, Tracheal

How does the Vesicular breath sound?

It’s heard in most of the lung tissues. Its soft. Inspiration is longer than an expiration.

How does the bronchovesicular breath sound?

Usually heard between scapulae. moderate sound. Inspiration and expiration are equal.

How does the bronchial breath sound?

Usually heard above the Manubrium. It’s loud. Expiration longer than inspiration.

How does the Tracheal breath sound?

It’s usually heard above the trachea in the neck. It’s very loud. Inspiration expiration rationale equal.

Provide possible Adventitious or Added Breath Sounds

Crackles (or Rales), Wheezes and Rhonchi

Describe the crackle sounds

Discontinuous, non-musical, brief, fine or coarse sounding.

Describe the wheezing or Rhonchi sounds

Continuous, prolonged (not necessarily throughout the respiratory cycle), high-pitched or low pitched.

What is Bronchophony, and what is it used for?

The subject is asked to say "44" or “99”, the finding is positive when heard loudly. It assists in determining consolidation (lung filled with fluid) of the lung

What is whispered pectoriloquy, and what is it used for?

When you hear the patient whispering. It assists in determining consolidation (lung filled with fluid) of the lung.

What is Egophony, and what is it used for?

The subject is asked to say "ee", the finding is positive when they hear "ay". It assists in determining consolidation (lung filled with fluid) of the lung

What does atelectasis cause?

In the case of a major bronchial obstruction, collapse of the lung tissue beyond the obstruction.

What does Chronic Bronchitis cause?

Chronic inflammation of the bronchi

What does left sided heart failure (early stage) cause?

Pulmonary Vein congestion, Edema in the interstitium and the bronchial mucosa.

What consolidation in the lungs cause?

Alveoli (air sacs) filled with fluid or blood. Pneumonia. Pulmonary edema or pulmonary Hemorrhage.

COPD

Chronic obstructive pulmonary disease

What is COPD / Emphysema?

A chronic obstructive lung disease, most often caused by long-term smoking. Emphysema is a subtype involving destruction of alveolar walls, leading to large air spaces instead of many small alveoli.

What is the effect and clinical presentation of COPD?

Would reduce surface area for gas exchanged, and decrease lung elasticity. Present as chronic shortness of breath, cough, and often Hyperinflation.

What is the definition of asthma?

Chronic inflammatory disease of the airways, usually with intermittent flareups, often triggered by allergen or irritants

What is the effect and clinical presentation of asthma?

Narrowing of the airways and reduced airflow, especially during exhalation leading to hyperinflation. Present as wheezing, shortness of breath, coughing, especially at night or after exertion

What occurs during an asthma attack?

Constriction of smooth muscles around the bronchi, swelling of the airway lining and increased mucus production.

What causes Pleural Effusion?

Accumulation of fluid between the two pleural layers (the membranes surrounding the lungs).

What are the effects and clinical presentations of plural effusion?

Fluid pushes lung tissue inward causes to move away from chest wall reduces effectiveness of lung volume. Present says shortness of breath, possibly poetic, chest pain, dullness on physical exam

What causes Pneumothorax?

Entry of air into the pleural cavity – the space between the two pleural layers.

What is the effect and clinical presentation of A pneumothorax?

Pressure from air causes the affected lung to collapse, partially or completely, Present as sharp chest pain, shortness of breath, reduce chest expansion on the affected side