Thoracic Landmarks and Red Flags
Where should you place the needle for a thoracentesis? Why?
At the SUPERIOR rib margin to avoid the neurovascular bundle (VAN runs inferior to ribs)
What are the 4 classic techniques used to examine the lungs?
Inspection, Palpation, Percussion, and Auscultation
What breath sound is high-pitched, musical, and commonly associated with narrowed airways?
Wheezes
AP:transverse ratio of 1:1 (increased AP diameter), hyperresonant percussion, coarse crackles, wheezes, and delayed expiration
COPD
Influenza vaccine ages and schedule
Ages 19 or older: 1 dose annually
Note: people with an egg allergy CAN receive the vaccine even if its egg based
What is the "triangle of safety" and what is it used for?
A triangular area bordered by the pectoralis major muscle, latismuss dorsi muscle, and 5th intercostal line/nipple. It is the area used for CHEST TUBE INSERTION (midaxillary line)
What pattern should you auscultate the lungs in?
Ladder
Note: have patient cough first!
What are rales and rhonchi? Which one is cleared with cough?
Rales: crackles - can be fine (soft/high pitched) or coarse (loud/high pitched)
Rhonchi: continuous low pitched snoring sound - CLEARED W COUGH
Dull percussion, increased tactile fremitus, and bronchial breath sounds over one area of the lung
Lobar pneumonia
What is the STOP-Bang criteria for OSA?
S: snoring, T: tiredness, O: observed apnea, P: pressure (HTN) - B: BMI >35, A: age > 50, N: neck > 40 cm, G: gender (male)
0-2 low, 3-4 intermediate, 5-8 high risk
Which intercostal space is a needle decompression preformed for tension pneumothorax?
2nd intercostal space
What does tactile fremitus assess? When is it increased?
Vibrations transmitted through the chest wall. Increased with lobar pneumonia, pulmonary edema, and lung tumor
What will the percussion, breath sounds, and tac frem sound like for atelectasis?
Percussion: DULL
Breath sounds: ABSENT
Tac Frem: ABSENT
Hyper resonant percussion, decrease breath sounds, and decreased tactile fremitus on one side
Pneumothorax
What 3 criteria are required for annual low dose CT lung cancer screening?
1. Age 50-80
2. ≥ 20 pack year smoking hx
3. currently smoking or quit within 15 years
SCREENING (ran out of space in other column); what are the two TB screening tests
IGRA blood test (quantiferon gold) and TB skin test (read induration at 24-48 hours)
What finding indicates air in the subcutaneous tissue?
Crepitus (crackling/grinding sound)
Describe pleural rub and the best place to hear it
Grating and biphasic. Loudest in axilla/base of lung
Dull-flat percussion, decreased breath sounds, and decreased tactile fremitus
Pleural effusion
COVID vaccine ages and schedule
Ages 19-64 (not pregnant): 1 or more doses of 2024/2025 vaccine
Ages ≥ 65: 2 or more doses of 2024/2025 vaccine
What is the numerical range of normal diaphragmatic excursion?
3 - 5.5 cm
What happens to the trachea in atelectasis? What about in large pleural effusion?
Atelectasis: shifts TOWARDS affected side
Large Pleural Eff: shifts AWAY from affected side
What does a mediastinal crunch sound indicate?
Air in the mediastinum or pericardium heard with each heartbeat
Note: best heard over heart in left lat decub, happens during vomiting, heavy lifting, severe cough, or pressure changes bc ruptured alveoli
Stridor heard over the neck area. What is it and what should you do?
Upper airway obstruction - IMMEDIATE INTERVENTION
Tdap recommended ages and vaccine schedule
All adults get 1 Tdap, then repeat every 10 years. 1 Tdap given for every pregnancy. 1 Tdap for wound management