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| sternal angle of louis posteriorly |
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| can count up posteriorly from 12th rib |
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| exertional breathing muscles |
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– Sternocleidomastoids – Scalenes
– Pectoralis minor
– Abdominals (assist in expiration) – Internal intercostal` |
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| labored breathing muscles |
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Definition
• Forced inspiration
– Sternocleidomastoid, scalenes, and pectoralis minor lift chest upwards as you gasp for air.
• Forced expiration – Abdominal muscles
force diaphragm up.
– Internal intercostals depress ribs. |
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You can see muscles in neck working:
– Scalene
– Sternocleidomastoid – Trapezium
nasal flaring, grunting, abdominal retractions |
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| treache Deviated toward diseased side: |
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• Atelectasis
• Agenesis of lung
• Pneumonectomy
• Pleural fibrosis |
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| traches Deviated away from diseased side |
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• Pneumothorax
• Pleural effusion • Large mass |
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| occurs in instances of thick chest wall, bronchopulmonary obstruction, COPD, fibrosis, pleural effusion, PTX, or tumor (increased air = decreased fremitus) |
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| occurs by consolidation within the lung, like pneumonia or atelectasis (decreased air = increased fremitus) |
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Air trapping in the lung or pleural space can be seen in chronic conditions (emphysema) or acute ones (pneumothorax) will produce hyper-resonant
(more drum-like) notes on percussion. emphysema or bronchitis |
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| If normal, air-filled tissue has been displaced (moved over) by fluid, like in pleural effusion, or infiltrated with white cells and bacteria like in pneumonia, a deadened tone is generated. |
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| Over fluid or tissue generates a dull sound, pleural effusion or lobar pneumonia |
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| principle behind percussion |
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Definition
| The principle behind this is that striking a surface which covers an air-filled structure like the lung will produce a resonant sound. |
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| (soundslikeatympanicdrumlikethe stomach bubble)—possible PTX |
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| dec diaphragmatic excursion decent |
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Definition
| atelectasis of lower lobes, emphysema, diaphragmatic paralysis, pleural effusion, pain, abdominal changes such as tumors, and extreme ascites or penetrating trauma. |
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| low-pitched and heard over most lung fields (I>E). |
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| heard over the trachea and are loud and harsh (I=E). |
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| Bronchovesicular and bronchial sounds |
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Definition
| Bronchovesicular (I=E) and bronchial sounds (louder and higher pitched) are heard in between. E>I with bronchial breath sounds. |
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Term
| Breath Sounds, dec, shift, extra |
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Definition
• They are decreased when normal lung is displaced by air (emphysema or PTX) or fluid (pleural effusion).
• Breath sounds shift from vesicular to bronchial when there is fluid in the lung itself (pneumonia).
• Extra sounds that originate in the lung sand airways are referred to as adventitious sounds and are always abnormal but not always significant. |
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| high-pitched, musical. Heard during inspiration or expiration. Seen in asthma, COPD, CHF |
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| snoring or gurgling quality. Sounds like blowing air through milk with a straw. Seen in chronic bronchitis, pneumonia, and may clear with coughing |
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| high-pitched sounds both coarse and fine in inspiration or expiration. Take your fingers between your hair and rub them together or crush cellophane to recreate the sound. Seen in asthma, CHF, and bronchitis |
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| more upper airway; abnormal, high-pitched sound produced by turbulent airflow through a partially obstructed airway (not a lung sound) |
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heard best anterior lateral lung field if patient sitting upright
• Cause—inflamed pleura, parietal pleura rubbing against visceral pleura
• Has grating quality heard best during inspiration, doesn’t clear with coughing |
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| identification of fractured rib |
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Definition
| anterior compression of chest helps id |
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Term
Lung diseases affecting air sacs
(alveoli) |
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Definition
– Pneumonia
– TB
– Emphysema and COPD
– Pulmonary edema
– Lung cancer
– ARDS
– Pneumoconiosis |
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Term
| Lung diseases that affect the interstitium |
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Definition
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Lung diseases that affect blood
vessels |
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Definition
– Pulmonary embolism
– Pulmonary HTN |
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Term
| Lung diseases that affect the pleura |
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Definition
– PTX
– Pleural effusion
– Mesothelioma
– Pleurisy |
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Term
| Lung diseases affecting the airways |
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Definition
– Bronchitis
– COPD/emphysema
– Asthma
– CF |
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| other causes for lung changes or pulmonary chest pain |
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Definition
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| febrile, dullness to percussion over affected area, breath sounds are bronchial (loud expiratory sounds last longer than inspiratory, pause in between inspiration and expiration), crackles, fremitus, and transmitted voice sounds are increased. Egophony positive |
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Definition
| influenza, ETOH, smoking, COPD/asthma, splenectomy, immunocompromised, aspiration: AMS, dysphagia, GERD, seizure disorder |
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Definition
Loss of airspace caused by obliteration of the air containing alveoli which are filled with fluid
or blood
• Radiologic sign
• Causes:pneumonia (lobar), pulmonary edema, or pulmonary hemorrhage |
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Term
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Definition
• InfectionwithMycobacterium
tuberculosis
• Riskfactors:substanceabuse, immunocompromised, nutritional status, close living quarters
• Symptoms:fever,nightsweats, cough
• Imaging/labs:chestx-ray,TST, interferon-gamma release assays |
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Definition
• COPD and subtypes: emphysema, chronic bronchitis, and chronic obstructive asthma
• Mixture of a small airways disease (obstructive bronchiolitis) and parenchymal destruction (emphysema)
• Chronic inflammation causes structural changes, small airways narrowing, and destruction of lung parenchyma
• Loss of small airways may contribute to airflow imitation and mucociliary dysfunction, a characteristic feature of the disease
• The alveoli become over-distended and the alveolar septa are destroyed
• Irreversible except for asthma
• Risk factors: smoking, exposure to noxious gases
• Symptoms: dyspnea, chronic cough, and sputum production, exertional dyspnea, chest tightness
• PE: crackles, rhonchi, wheezes, percussion, fremitus, and transmitted voice sounds are normal
• Imaging/labs: CXR, CT, PFT, FEV1/FVC, spirometry, peak flow, lung volumes, diffusing capacity, ABG, forced expiratory volume, Alpha1, pulse ox |
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Term
| chronic bronchitis (COPD) |
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Definition
• Symptoms:chronic, productive cough for three months in each of two successive years in a patient in whom other causes of chronic cough have been excluded
• Excessive mucus production
• Risk factors: smoking |
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Definition
• A pathological term that describes some of the structural changes sometimes associated with COPD
– Abnormal and permanent enlargement of the airspaces distal to the terminal bronchioles that is accompanied by destruction of the airspace walls, without obvious fibrosis (to the naked eye)
– Various subtypes of emphysema
– Alpha1 antitrypsin may be cause • Inheriteddisorder
• PE: barrel chest, pursed lips, fremitus, and transmitted sounds decreased |
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Definition
• Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role.
• The chronic inflammation is associated with airway responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning.
• These episodes are usually associated with widespread, but variable, airflow obstruction within the lung that is often reversible either spontaneously or with treatment— Global Initiative for Asthma |
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| blue bloater/ pink puffer |
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Definition
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Definition
• Excess collection of watery fluid in the lungs, may be in alveolar space itself or in the lung tissue between the capillary walls and the alveoli
• Cardiogenic (CHF) or non- cardiogenic; also several other non-cardiogenic types
• Cause: cardiogenic or non-cardiogenic, ARDS, acute decompensated heart failure (ADHF), volume overload—(sodium retention in acute glomerulonephritis or blood transfusion, or IVF). Think if it’s related to ACS, then heart; if occurs with sepsis, likely non-cardiogenic
• Risk factors: severe asthma, HTN, DM
• Symptoms: SOB, orthopnea, CP
• PE: tachypnea, diaphoretic, wet rales, diastolic gallop (S3), percussion, fremitus, transmitted voice normal
• Imaging/Labs: CXR, ECHO if cardiac |
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Definition
• Loss of lung volume due to the collapse of lung tissue
• Different from lung collapse of a PTX. This is when the lung tissue itself collapses and compresses but does not pull away from supporting structures
• Air does not leak into the surroundings cavity. Rather, the alveoli deflate and lose air, or there is airlessness
• Obstructive (either mucus or FB) and non- obstructive types
• Symptoms: not always; SOB and cyanosis possible |
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Term
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Definition
• Classified as either small cell lung cancer (SCLC) or non-small cell lung cancer (NSCLC)
• Risk factors: smoking, radiation, environmental toxins, pulmonary fibrosis, HIV, genetic factors, ETOH
• Symptoms: cough, hemoptysis, CP, dyspnea, hoarseness
• Imaging/labs: CXR, tissue biopsy |
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• ARDS: an acute, diffuse, inflammatory lung injury that leads to increased pulmonary vascular permeability, increased lung weight, and a loss of aerated tissue
• Hypoxemia and bilateral radiographic opacities; pathological hallmark is diffuse alveolar damage
• Risk factors: more than 60 different conditions, sepsis, OD, trauma, aspiration
• Symptoms: appear within 6 to 72 hours of an inciting event—dyspnea, cyanosis (hypoxemia), and diffuse crackles, tachypnea, tachycardia, diaphoresis, use of accessory muscles of respiration, cough, and chest pain
• Imaging/labs: ABG—respiratory alkalosis, elevated AA gradient, CXR, CT |
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Definition
• Occupational lung disease and restrictive lung disease caused by the inhalation of dust—silicosis, asbestosis, coal workers, etc.
• Small particles that move into alveoli and pulmonary macrophages promote inflammation, fibrosis, and alveolar damage
• Type of ILD
• Symptoms: SOB
• Risk factors: coal, carbon, aluminum, asbestos, silica, bauxite, beryllium, iron, cotton, tin
• Imaging: CXR, PET scanning |
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| Acute (<3 Weeks) cough could be |
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Definition
• URI
• Pneumonia • PE
• Congestive heart failure |
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Term
| Subacute (3–8 Weeks) cough |
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Definition
• Viral infections • Post-nasal drip • GERD
• Post infection |
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Term
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Definition
• Pulmonary TB
• Bronchial asthma
• COPD
• Bronchogenic carcinoma
• Eosinophilic bronchitis
• Post-nasal drip
• GERD
• ACEI
• CHF |
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Term
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Definition
• Post-nasal drip
• GERD
• Chronic bronchitis
• Bronchial asthma
• Obstructive sleep apnea
• Left ventricular heart failure
• Aspiration |
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Definition
• Currant jelly sputum—associated with pneumonia, infections with Klebsiella pneumoniae
• Rusty-colored sputum— Streptococcal pneumoniae infections (also associated with other causes)
• Yellow/green—bacterial infection; associated with acute and chronic bronchitis, acute pneumonia
• Mucoid—clear, globular; think asthma/allergy
• Pink frothy—pulmonary edema
• Blood—TB
• Black—coalworkerpneumoconiosis
• Clearmucoidsputum—associatedwithnormal and asthma
• Odor—foul?Thinkabscessandanaerobic bacterial infections
• Consistency—thickandverysticky,thinkCF
• A lot(abscess/bronchiectasis/CF) |
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Definition
• PTX
• PE
• FB inhalation
• Laryngeal edema
• Left heart failure |
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Definition
• ARDS
• Pneumonia
• Bronchial asthma • Left heart failure |
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Term
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Definition
• COPD
• ILD
• Pleural effusion • Anemia
• Thyrotoxicosis
• Left heart failure |
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