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PDx - Pulmonary
n/a
30
Medical
04/23/2011

Additional Medical Flashcards

 


 

Cards

Term
Understand what is meant by the terms consolidation and atelectasis. What mechanismis responsible for atelectasis?
Definition

consolidation - replacement of alveolar air with solidified lung that can transmitt higher frequency sounds better; decreases air/fluid ratio

 

atelectasis is a type of consolidation in which air is reabsorbed into the blood serum distal to a physicla obstruction of an airway => aveolar collapse => dense infiltrates, crowding of the ribs, and shifting of the affected interlobal fissures on x-ray; also decreases air/fluid ratio

Term
Differentiate between obstructive lung disease and restrictive lung disease.
Definition

obstructive lung disease - decreased expiratory flow resulting from increased airway resistance => air trapping => pulmonary hyperinflation => increases air/fluid ratio

 

asthma, emphysema, bronchitis, bronchiectasis, cystic fibrosis,

 

restrictive lung disease - decreased inspiratory flow resulting from decreased pulmonary compliance => air can't get in, because lungs are stiff => decreases air/fluid ratio

 

pulmonary fibrosis

Term
Understand the mechanism producing a pneumothorax. Be able to differentiate between a pneumothorax and a tension pneumothorax in terms of history and physical findings.
Definition

pneumothorax - atmospheric air pressure enters the pleural space, causing lung collapsechest wall expanding outward, and visceral and parietal pleura to separate from each other

 

symptoms of a pneumothorax are determined by the size of the air leak and the speed by which it occurs; they may include chest pain in most cases and shortness of breath in many. The diagnosis can be made by physical examination in severe cases but usually requires a chest X-ray or computed tomography (CT scan) in milder forms. In a small proportion, the pneumothorax leads to severe oxygen shortage and low blood pressure, progressing to cardiac arrest unless treated; this situation is termed tension pneumothorax.

 

History: tension pneumothorax - a stab wound or gunshot wound, allows air to enter the pleural space, or because of injury to the lung; receiving mechanical ventilation

 

pneumothorax - lung disease, or spontanous

Term
Know how to identify the angle of Louis.
Definition
Term
Know the imaginary topographical landmarks of the thoracic cage commonly used in the physical exam.
Definition

lung boundaries

 

superiorly - lungs extend 3-4 cm above the clavicles

 

inferiorly - lunch extend to the 6th rib in the midclavicular line; 8th rib in midaxillary line, and 9-12 rib posteriorly

 

trachea bifurcates at the level of the sternomanubrial angle anteriorly, and T4 posteriorly

Term
Know the anatomic boundaries of the lungs within the thoracic cage.
Definition
Term
Recognize the topographic projection of lung segments on the chest wall as represented during auscultation.
Definition

anteriorly - upper lobes and right middle lobe dominate the findings

 

laterally - right middle lobe (well over the lateral chest wall)

 

posteriorly - lung sounds from lower obes dominate the surface area of chest wall; above the scapula (T3) is where you can hear upper lobes posteriorly

Term
What is the normal ratio of the AP diameter of the thoracic cage to the lateral diameter? In which conditions does this ratio deviate from the norm?
Definition
the normal AP/L diameter is 0.70 to .75, when it exceeds > .90 => obstructive disease (e.g. asthma or emphysema) => can't get air out
Term
Know what is meant by respiratory paradox. What is its significance?
Definition

normally, abdominal wall moves synchronously outward with the chest wall during inspiration and retracts synchronously with the chest wall during expiration

 

respiratory paradox - chest wall moves outward, but abdominal wall moves inward with inspiration

 

significance => diaphragmatic weakness or paralysis

Term
How does thoracic expansion vary in obstructive lung disease? Restrictive lung disease?
Definition

less than 4 cm is abnormal

 

obstructive lung disease - since there's increased air/fluid ratio, you'd expect thoracic expansion to increase, but it decreases

 

restrictive lung disease - thoracic expansion decreases

 

also in pneumothorax

Term
By what mechanism does the subcostal angle narrow in pulmonary emphysema?
Definition
in pulmonary emphysema, so much air is trapped that
Term
Understand the mechanism responsible for tactile fremitus and how it is measured.
Definition

tactile fremitus - when larynx generates sound, the sound is transmitted downward through the tracheobronchial tree, into the lung parenchyma, across the pleural surface and chest wall => palapble thrill on surface of chest wall

 

measured symmetrically from side/side and top/bottom

Term
Explain how tactile fremitus will be affected in each of the following conditions: pulmonary edema, tumor obstructing an airway, pneumothorax, atelectasis, pleural effusion, emphysema, pneumonia, and foreign body obstruction.
Definition

pulmonary edema - since consildation dec. air/fluid ratio, expect increased tactile fremitus

 

tumor obstructing an airway - expect dec. tactile fremitus, since a large airway obstruction lessens the intensity of VTF

 

pneumothorax - since it inc. air/fluid ratio, expect dec. tactile fremitius

 

atelectasis - since it dec. air/fluid ratio, expect inc. tactile fremitus

 

emphysema - since it inc air/fluid ratio, expect dec. tactile fremitus

 

pneumonia - since it dec. air/fluid ratio, expet inc. tactile fremitis

 

foreign body obstruction - since it obstructs large airways, less air can be used to produce a VTF => dec. tactile fremitis

Term
Understand the mechanisms responsible for tracheal deviation. For the following conditions, decided how the position of the trachea will be affected: atelectasis on the right, pneumothorax on the right, massive pleural effusion on the right, tension pneumothorax on the right, pneumonia on the right.
Definition

tracheal deviation - relative volumes on the thoracic cage, and tractive forces on the large airwas can pull the trachea away from the midline

 

atelectasis on the right - pulls trachea toward right

 

pneumothorax on the right - pulls trachea towards left

 

massive pleural effusion on right -> pulls trachea towards left

 

tension pneumothorax on the right -> pulls trachea to left

 

pneumonia on right -> pulls trachea to left

Term
Understand the technique used to properly percuss the chest. Understand the mechanism responsible for the generation of a variety of percussion notes.
Definition

character of note - density of the tissue through which the sound waves pass. Water-dense tissue  - high pitched note of low intensity; air -dense tissue produces a low-pithced note of high intensity

 

tympany - lowest pitched and loudest of the notes - highest air/fluid ratio - pneumothorax

 

hyperresonnce - low pitched note high air/fluid ratio -> emphysema or smaller pneumorthorax

 

resonance - low pitched during normal breathing

 

dullness - low air/fluid ratio - consolidation or pulmonary fibrosis

 

flatness - lowest air/fluid ratio - large pleural effusion

Term
Know how to check for diaphragmatic excrusion. What are the normal limits of excursion? Why does one hemidiaphragm percuss higher than the other in normal individuals?
Definition

normal limits of excursion - 3-6 cm

 

the right hemi-diaphragm normally percusses 1 to 2 cm higher than the left hemi-daiphgram, each hemi-diaphragm should move about the same distance

 

the left hemidiaphragm will percuss higher than the right hemidiaphgram when there is paralysis of the left hemi-diaphragm

Term
What is the significance of dullness to percussion, increased tactile fremitus, and egophony at the tip of the left scapula?
Definition

dullness to percussion - implies consolidation either due to pneumonia (local) or pulmonary fibrosis (widespread)

 

increased tactile fremitus - implies consolidation

 

egophony at the tip of left scapula - pulmonary consolidation

Term
Characterize vesicular, bronchovesicular and bronchial breath sounds in terms of quality, predominance of the inspiratory and expiratory components, and area of the chest where these sounds are normally heard.
Definition

vesicular - long inspiratory, short expiratory, normally heard on periphery of lung

 

bronchovesicular - equal inspiratory and expiratory, normally heard over central large airways parasternal or between the scapula

 

bronchial breath sounds - short inspiratory, long expiratory, heart over the intrathoracic trachea

Term
Explain where inspiratory and expiratory breath sounds are thought to originate on pulmonary auscultation.
Definition

expiratory breath sounds - turbulent flow in the large bronchi and trachea

 

inspiratory breath sounds - vorticose airflow in the smaller branching lobar and segmental airways

Term
Explain the mechanism by which bronchial breath sounds occur over peripheral segments of lung in consolidation.
Definition

bronchial/bronchovesicular breath sounds over the periphery - implies decrease in air/water ratio

 


Term
What is the mechanical basis for the pulmonary crackle?
Definition

crackle has two mechanisms

 

(1) opening of small airways due to the sudden equalization of pressures between the small airways and the alveoli

 

(2) breaking of small bubbles or mucus films located in the medium to large conducting airways

 

 

Term
What is the significance of "velcro" crackles?
Definition

velcro crackles => pulmonary fibrosis

 

small bronchioles and aveolar ducts opening

Term
Relate the location of crackles in the respiratory cycle to the mechanism responsible for their production.
Definition

early-mid inspiratory crackles => large-to-medium sized airways => bubbling of air through thin secretions

 

obstructive disease

 

late-inspiratory crackles => small bronchioles and alveolar ducts -> popping open during inspiration

 

consolidation - pulmonary edema or pneumonia

or pulmonary fibrosis

Term
Explain how wheezes are thought to arise. What is the significance of inspiratory wheezes versus expiratory wheezes?
Definition

wheezes - caused by vibrations of the opposing walls of narrowed airways

 

best predictor of airway obstruction

 

inspiratory wheezes - severe obstruction

expiratory wheezes - obstruction due to asthma, intrabronchial tumor, or foreign body

Term
Know the common causes of wheezes.
Definition

polyphonic wheezing - asthma

 

monophonic wheezing - intrabronchial tumor or foreign body

Term
What is the significance of localized wheezing versus diffuse wheezing?
Definition

localized wheezing - more likely to be focal airway obstruction (foreign body aspiration, or tumor)

 

diffuse wheezing - more likely to be asthma

 


Term
Understand what is meant by stridor and what is suggests.
Definition

stridor - loud, long, high-pitched musical inspiratory sound

 

=> upper airway obstruction

 

inspiration stridor -> tracheal, epiglottic, or laryngeal obstruction => medical emergency (croup)

 

expiratory stridor -> aspirated foreign body

Term
Explain the mechanism by which bronchial breath sounds are sometimes heard over the midthoracic vertebrae.
Definition

bronchial breath sounds over the midthoracic vertebrae (d'Espine's sign) =>

 

mass located in the posterior mediastinum

 

lymph node enlargement

Term
Does the normal lung transmit sounds of high or low frequency? Describe three ways that a physician can use the patient's voice sounds to check for areas of consolidation. Which of these is the most sensitive?
Definition

low frequncy conversational speech is transmitted; higher frequency is lost normally

 

bronchophony - spoken voice increased transmission over chest wall

 

whisphered pectoriloquy - increased in transmission of high-pitched whisphered sounds (66 please); periphery is compared to the trachea

 

egophony - long e -> long 'a' -> most sensitive finding for pulmonary consolidation

Term
Explain the mechanism responsible for auscultatory percussion.
Definition