Bates Ch 8 - Thorax & Lungs with Unit 6 terms

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1.

Sternal angle

junction of manubrium, body of

sternum, 2nd rib

2.

trachea bifurcates

sternal angle - anteriorly;

T4 spinous process - posteriorly

20.

anaerobic lung
abscess
sputum

produces large amounts of purulent, foulsmelling sputum, also present in

bronchiectasis

21.

regular
respiration
rate

14-20 respirations per min

22.

nail clubbing

lung abscesses, malignancy, congenital

heart disease, bronchiectasis, pulmonary
fibrosis, and cystic fibrosis.

23.

stridor on
INSPIRATION
especially

high-pitched wheeze signaling upper

airway obstruction in larynx or trachea

24.

signs of
dyspnea

Accessory muscle use and retractions,

inspiratory contraction of sternocleido
mastoid & scalenes at rest

25.

causes of
tracheal
deviation

pneumothorax, pleural effusion, atelectasis

26.

pectus
excavatum

depression of lower portion of sternum

27.

barrel chest

increased AP diameter; if 1:1 thoracic ratio =

COPD

28.

pectus
carinatum aka
pigeon chest

anteriorly displaced sternum

29.

flail chest

paradoxical movements of thorax; 3 ribs

fractured at 2 places each

30.

normal lung
sounds

mostly vesicular breath sounds

31.

bronchophony

patient spoken words louder, clearer with

consolidation

32.

egophony

spoken "ee" heard as "ay" with

consolidation

33.

whispered
pectoriloquy

whispered words heard - normally not

34.

causes of late
inspiratory
crackles

interstitial lung disease (fibrosis),

pneumonia

35.

causes of early
inspiratory
crackles

chronic bronchitis, asthma

36.

causes of
wheezes

narrow bronchi. asthma, C O P D, chronic

bronchitis, CHF

2nd intercostal
space for
procedure

Needle insertion for tension

pneumothorax

4th intercostal
space for
procedure

Chest tube insertion

5.

T7-T8 (procedure)

Thoracentesis

6.

Apex of lung,
location

~2-4 cm above inner third of clavicle

7.

Lower border of
lung, position

6th rib at M C L to the 8th rib at

midaxillary line, T10 posteriorly

8.

bifurcation of
trachea, location

sternal angle (anterior), T4 (posterior)

9.

causes of
myocardial chest
pain

angina pectoris, MI

10.

causes of
pericardial chest
pain

pericarditis

11.

causes of aortic
chest pain

dissecting aortic aneurysm

12.

causes of
tracheal/bronchial
chest pain

bronchitis

causes of pleuritic
chest pain

pericarditis, pneumonia

causes of
musculoskeletal
chest pain

costochondritis, herpes zoster

causes of
esophageal chest
pain

reflux esophagitis, esophageal spasm

causes of neck or
abdominal chest
pain

cervical arthritis, biliary colic, gastritis

most common
cause of pediatric
chest pain

anxiety

wheezes - on
expiration
normally

suggests partial airway obstruction

from secretions, tissue inflammation, or
foreign body

37.

causes of silent
chest

severe obstructive pulmonary disease

causes of general
cough

Left sided heart failure

38.

cause of
localized
wheezing

partial bronchial obstruction; tumor, foreign

body

3.

4.

13.

14.

15.

16.

17.

18.

19.

39.

stridor

inspiratory wheeze often louder in neck

suggests partial obstruction of larynx or
trachea

40.

pleural rub

creaking sounds due to inflamed &

roughened pleural surfaces

41.

mediastinal
crunch

hamman sign; precordial crackles synced

with heart beat,sign of mediastinal
emphysema

normal
physical
findings

percussion resonant - not dull or hyper

trachea midline
breath sounds vesicular - over lung fields
tactile fremitus normal

findings of
chronic
bronchitis

percussion resonant normal

possible crackles in early inspiration; or
wheezes, ronchi
productive cough

signs of early
left-sided
heart failure

early or late inspiratory crackles; possibly

wheezes

45.

etiology of
left-sided
heart failure

increased pulmonary vein pressure leads to

congestion & interstitial edema

46.

signs of
consolidation

percussion dull over affected area

bronchial breath sounds - over periphy
shouldn't be
late inspiratory crackles over affected area
tactile fremitus increased with
bronchophony, egophony, & whispered
pectoriloquy

42.

43.

44.

47.

etiology of
consolidation

alveoli fill with fluid or blood cells. due to

pneumonia, pulmonary edema, pulmonary
hemorrhage

48.

signs of
atelectasis

percussion dull over area

trachea may deviate to affected side
usually absent breath sounds & tactile
fremitus except Right upper lobe

49.

etiology of
atelectasis

lobar obstruction. plug in mainstem

bronchus obstructs air flow, collapsing lung
tissue

signs of
pleural
effusion

percussion dull to flat

if large; trachea deviates away from
breath sounds decreased to absent
possible pleural rub
tactile fremitus decreased to absent - except
top or large effusion

50.

51.

etiology of
pleural
effusion

fluid accumulates in pleural space,

separating air-filled lung from chest wall,
blocking transmission of sound

52.

signs of
pneumothorax

percussion hyperresonant or tympanic

if large - trachea deviates away from
involved side
breath sounds decreased to absent
possible pleural rub
tactile fremitus decreased to absent

53.

etiology of
pneumothorax

air leaks into pleural space, usually

unilaterally, causing lung to recoil away
from chest wall. pleural air blocks
transmission of sound.

54.

signs of COPD

percussion diffusely hyperresonant

breath sounds decreased to absent
possible crackles, wheezes, and ronchi
with bronchitis
tactile fremitus decreased

55.

etiology of
COPD/emphysema

slowly progressive disorder in which the

distal air spaces enlarge and lungs
become hyperinflated

56.

signs of asthma

percussion resonant to diffusely

hyperresonant
breath sounds often obscured by
wheezes
wheezes, possibly crackles
tactile fremitus

57.

vesicular breath
sounds

soft, low pitched 3:1 I to E, gentle rustling

- heard normally over most of
peripheral lung fields

58.

bronchovesicular
breath sounds

equally long inspiratory & expiratory

sounds, moderate intensity & pitch,
between 1st and 2nd intercostal spaces
& between scapula 0- pathological
elsewhere

59.

bronchial breath
sounds

louder, higher pitched lung sounds 1:3 I

to E - expiratory longer, heard over
manubrium if at all, pathological
elsewhere

60.

crackles

discontinuous; intermittent, nonmusical,

inspiration or expiration

61.

causes of crackles

pneumonia, fibrosis, early CHF,

bronchitis, bronchiectasis

62.

causes of wheezes

narrowed airways asthma, COPD,

bronchitis

63.

causes of ronchi

secretions in large airways

64.

ronchi

continuous, low-pitched, prolonged

musical breath sound with snoring
quality

65.

wheezes

continuous, high-pitched, prolonged

musical breath sounds with hissing or
shrill quality

66.

diaphragm
position in COPD

displaced downward

67.

fractured rib

pain upon squeezing chest with hands on

sternum & thoracic spine

68.

fremitus is
decreased or
absent
when...

the voice is higher pitched of soft, vibrations

are impeded by thick chest wall, obstructed
bronchus, COPD, pleural changes from
effusion, fibrosis, air or an infiltrating tumor.

asymmetric
decreased
fremitus

unilateral pleural effusion, pneumothorax,

neoplasm due to decreased transmission of
low frequency sounds.

70.

asymmetric
increased
fremitus

in unilateral pneumonia from increased

transmission through consolidated tissue.

71.

Hyperresonnace

general heard over hyper inflated lungs of

COPD or asthma. unilateral suggests a large
pneumothorax or possibly large air-filled bulla
in the lungs.

72.

Liver
location

abnormally high- suggest pleural effusion or

high diaphragm caused by atelectasis or
phrenic nerve paralysis

73.

Abnormal
sounds hear
with
auscultation

gowns can cause noise- ask patient to disrobe

hair can cause crackling sounds- press hard or
wet hair
if the patient is cold or tense- muscle
contraction sounds- muffled low pitched
rumbling o roaring noises can be heard

tracheal
breath
sounds

very loud, harsh sounds that are heard by

listening over the trachea in the neck

pump
handle
motion ribs increase AP
diam

1-3

bucket
handle
motion ribs increase
lateral diam

4-10

77.

caliper
motion ribs

11-12

78.

inhalation
restriction
aka

exhalation dysfunction

79.

inhalation
restriction
when

area fails to expand; uppermost rib stuck

down - had dysfunction during exhalation &
stuck there

80.

exhalation
restriction
aka

inhalation dysfunction

69.

74.

75.

76.

81.

exhalation
restriction when

area fails to compress; lowermost rib

stuck up - had dysfunction during
inhalation & stuck there

82.

inhalation
restriction - sign

wider Intercostal space ABOVE bad rib

83.

exhalation
restriction - sign

wider intercostal space BELOW bad rib

84.

breath sounds
from first AID

85.

red margin notes

...

86.

cough can be a
symptom of

left sided heart failure

87.

sinus tracts blind

inflammatory
tubelike
structures
opening onto the
skin

rare - indicate infection of pleura & lung,

T B and actinomycosis

88.

causes of
unilateral chest
movement
deficiency or
"splinting"

fibrosis, pleural effusion, lobar

pneumonia, or bronchial obstruction

89.

causes of
asymmetric
fremitus
decreases

unilateral; pleural effusion,

pneumothorax, neoplasm

90.

when percussing only 1 finger

touching!!

aim middle finger (plexor) at distal

interphalangeal joint of pleximeter finger

91.

when percussing if needs to be

louder

more pressure with base finger (not

tapping finger)

92.

flat percussion
note - like in
thigh

large pleural effusion

93.

dull percussion
note - like in liver

lobar pneumonia

94.

resonance
percussion note
in - like in healthy
lung

simple chronic bronchitis

95.

hyperresonant
percussion note
in

COPD, pneumothorax

96.

tympanic percussion
note in

large pneumothorax

116.

Atelectasis

Complete or partial collapse of a lung

97.

level of diaphragmatic
dullness - abnormally
high

pleural effusion or atelectasis, or

paralysis

117.

Biot's
breathing

Patterns of quick, shallow breathing

followed by periods of apnea

118.

Bradypnea

Slow breathing rate

98.

breath sounds
decreased when

air flow decreased or when

sound transmission poor

119.

Bronchitis

Inflammation of the lining of the bronchial

tubes

99.

decreased breath
sounds with

obstructive disease or weakness,

effusion pneumothorax or COPD

120.

Consolidation

Accumulation of solid/liquid material in a

normally aerated lung

100.

a silent gap between

inspiratory & expiratory
sounds suggests

bronchial breath sounds

121.

Costal Angle

Angle of the ribs

122.

Cyanosis

Bluish discoloration of skin

123.

101.

fine late inspiratory

crackles that persist
from breath to breath
suggests

abnormal lung tissue (not just

airways)

Dyspnea

Difficulty breathing

124.

Egophony

A test for consolidation where the patient is

asked to say "E" while the provider
ausculates the lungs. An area of
consolidation is encountered when the "E"
is perceived as an "A"

102.

patients with COPD

prefer to sit

leaning forward - tripod position,

with pursed lips during
exhalation

125.

Emphysema

Destruction and over-inflation of alveoli

only a very large effusion

detected anteriorly

because pleural fluid usually

sinks posteriorly in a supine
patient

126.

Empyema

Pus in the pleural space

127.

Excursion

One complete movement of expansion and

contraction of the lungs and their
membranes

dullness of right middle

lobe pneumonia
typically occurs

behind right breast - need to

displace breast to hear it

128.

Fremitus

Vibration transmitted throughout the body

129.

displace liver & diaphragm

downward

Friction rub pleural

Audible medical sign stops with breathing;

pericardial rub does not

lung affected by COPD

may

130.

rachitic rosary at
costochondral joints
due to

calcium deficiency; rickets or

hypothyroid causes

Kussmaul
Breathing

Deep and labored breathing associated

with metabolic acidosis

131.

Manubrium

The broad, upper part of the sternum

132.

107.

pulmonary
embarrassment is

rapid shallow breathing,

inspiratory dyspnea

Pectus
Carinatum

Chest and rib cage abnormality that causes

the chest to bow out

133.

with respiratory distress

avoids lying down

because it keeps fluid pooled to

bases only

Pectus
Excavatum

Breastbone sinks into chest

108.

134.

Rales

respiratory distress signs

in infants

nasal flaring - are obligate nose

breathers, RR can be greater
than 50, sucked in sternum,
grunting

Fine rattling sound when examining

unhealthy lungs

135.

Rhonchi

Coarse low pitched rattling sounds caused

by secretions in bronchial airway

pallor a sign of

anemia, hypoperfusion

136.

110.

Stridor

111.

clubbing sign of

hemoglobinopathy or heart/lung
disease

High pitched sound that can be heard

without a stethoscope. Usually hear during
inspiration

137.

Tactile
Fremitus

Vibration palpated with the hand

138.

Tachypnea

Abdnormal rapid breathing

139.

Wheeze

Whistling or rattling heard in the chest

during exhalation

140.

Whispered
Pectoriloquy

Technique of assessment where the patient

whispers a word that is perceived to have
an increase in volume or clarity as the
provider ausculates

103.

104.

105.

106.

109.

112.

Adventitious Sounds

Added sounds superimposed on

breath sounds

113.

angle of Louis

Another name for the sternal

angle

114.

Apnea

cessation of breathing

115.

Asthma

Lung disease that inflames and

narrows airways