What is the term for the major fissures that divide the lung lobes
Oblique
Name the anatomical landmarks that are associated with the division of the L & R bronchus.
Level of T4-T5 ribs and just below the junction between the manubrium and the sternum.
What is the angle of Louis
A visible & palpable angulation representing the manubriosternal junction. 2nd rib attaches here.
Describe vetebral prominens
Spinous process of C7 highly visible and protruding when pt tucks chin. Landmark.
Describe the costal angle
Blending of costal margins where they attach to sternum
Lobar PNA & Pleural effusion will cause what type of a percussive sound?
Dull
What is the indentation above the sternum
Suprasternal Notch
What is a normal and abnormal thoracic ratio?
0.70 is normal with the AP diameter 70% of the Lateral diameter. A 1.0 thoracic ratio is a "Barrel chest" and typically has associated Kyphosis & an accentuated sternal angle
A patient has a protrusion coming from their chest. What is this?
Pectus carinatum (pigeon chest)
A patient has an indentation in their anterior rib cage. What is this?
Pectus excavatum
Term for SOB that begins with lying down
Orthopnea
Term for SOB that starts suddenly while sleeping
Paroxysmal nocturnal dyspnea
Term for SOB that increases in upright position
Platypnea
10 P's that can cause dyspnea of rapid onset
PNA, Pneumothorax, Pulmonary constriction/asthma, Peanut/foreign body, PE, Pericardial tamponade, Pump failure, Peak seekers(high altitude), Psychogenic, Poisons
Rapid breathing associated with metabolic acidosis is called
Kussmaul Breathing
Intermittent breathing of varying depths typically associated with severe illness is called
Cheyne-Stokes
A pleural friction rub is loudest on inspiration or expiration?
Inspiration
What type of percussive sound denotes the stomach
Tympany
What type of percussive sound denotes the lung spaces?
Resonance
What type of percussive sound denotes the Liver space?
Dullness
Way to estimate Forced Vital Capacity with no special equipment
Have the pt exhale then hold their breath. Count the seconds until a breath must be taken. Multiply the seconds by 50 to get an approximated cc's of FVC!
The pregnant woman increases her ventilation by about 40%, is this accomplished via an increase in frequency or depth of respiration?
Depth is increased through a decease in functional residual capacity (FRC).
A patient presents to you with wheezing and pulmonary findings. Of the possible etiologies of viral, bacterial, or astham
Wheezing with pulmonary findings is rarely bacterial in nature and viral or asthma etiology should be explored.
What is the relationship between birth weight and asthma?
Low birthweight has no affect. High birthweights over 4.5 kg are associated with more asthma later in life. 20% asthma @ 4.5 kg and an additional 10% in prevalence for every 0.10 kg over 4.5 kg.
Pt presents with sudden L lateral chest pain, rapid shallow breaths, and has a mild fever. You can auscultate a rub. What general condition might this pt have?
Pleurisy of unknown etiology
A pleural effusion in which the fluid is purulent exudate is referred to as a...
Empyema
What changes will a large PE invoke on an EKG?
S1Q3T3, S depression lead I, Q depression Lead III, T wave inversion in lead III.
What type of a symptom scoring system can be used to estimate probability of PE?
Wells score:
Clinical signs and symptoms of DVT +3
Alternative diagnosis is less likely than PE +3
Heart rate >100 +1.5
Immobilization/Surgery in previous 4 weeks +1.5
Previous DVT/PE +1.5
Hemoptysis +1
Malignancy +1:
<2 points, low clinical probability;
Which organism almost always causes epiglottitis?
Haemophilus inlfuenzae type B
A 5 yo pt presents in an anxious state, is drooling from an open mouth and is unable to swallow. Pt does not want to lie down and prefers sitting straight up. What could this patient have?
Epiglottitis. Do NOT try to visualize the epiglottitis unless you are preparing to intubate. Medical emergency.
A young infant 4 mths appears in respiratory distress, severely tachypnea, rapid short breaths, c wheezing, and marked hyperinflation of lungs. Rhinorrhea c excess secretions noted. What could this be?
Bronchiolitis distinguished by hyperinflation respiratory distress. Typically in infants under 6 months. Viral cause typically respiratory syncytial virus (RSV).
Cachectic
adjective of cachexia: general physical wasting and malnutrition usually associated with chronic disease. The patient appears cachectic.
A 41yo cystic fibrosis patient has worsening respiratory PNA symptoms with large sputum production. Her X-ray shows her bronchial & bronchioles are dialated. What pathology best describes her lungs?
Bronchiectasis is an irreversible dilation of ?1 airways accompanied by recurrent transmural bronchial infection/inflammation and chronic mucopurulent sputum production.
Generally classified into cystic fibrosis (CF) and noncystic fibrosis (non-CF) bronch
During assessment of vocal resonance, you note that sound is intensified, that there is a nasal quality to the voice, and that e's sound like a's. This is indicative of:
Egophony in areas of/ indicative of lung consolidation.
Shortness of breath (dyspnea) which occurs when lying flat is called?
Orthopnea