#2: Pulmonary H&P

Question 1

The spine is deviated posteriorly

Answer 1

Kyphosis

Question 2

The spine is deviated laterally

Answer 2

Scoliosis

Question 3

Prominent eternal protrusion aka “Pigeon Chest”

Answer 3

Pectus carinatum

Question 4

Indentation of the lower sternum above the diploid aka “Funnel Chest”

Answer 4

Pectus excavatum

Question 5

Normal A/P to Transverse Diameter Ratio:

Answer 5

1:2

Question 6

Describe “Barrel Chest” characteristic findings: (6)

Answer 6

1- ribs are more horizontal
2- the spine somewhat kyphotic
3- sternal angle more prominent
4- trachea may be posteriorly displaced
5- AP diameter is increased 
6- occurs from long-standing compromised respiration

Question 7

SOB that increases in the upright position

Answer 7

Platypnea

Question 8

Rapid, deep, and labored breathing

Answer 8

Kussmaul respiration’s

Question 9

Varying periods of increasing depth interspersed with apnea

Answer 9

Cheyne-Stokes respirations

Question 10

Factors that increase respiration rate: (7)

Answer 10

1- pain
2- exercise 
3- metabolic acidosis
4- ASA poisoning
5- hypoxemia
6- Anxiety
7- CNS lesions of the pons

Question 11

Factors that decrease respiration rate: (6)

Answer 11

1- metabolic alkalosis
2- extreme obesity
3- excellent fitness
4- CNS lesions of the cerebrum
5- narcotic OD
6- MG

Question 12

MC type of respirations at all ages:

Answer 12

Thoracic respiration

Question 13

This population may typically display abdominal respiration

Answer 13

Very young infants

Question 14

Vibration sensation of the chest wall that results from speech/verbalizations

Answer 14

Tactile fremitus

Question 15

Tactile fremitus is best palpated here:

Answer 15

2nd ICS (where the bronchi typically bifurcate)

Question 16

Factors contributing to decreased or absent tactile fremitus: (4)

Answer 16

1- bronchial obstruction
2- emphysema
3- excess air in the lungs
4- pleural thickening or effusion

Question 17

Factors contributing to increased tactile fremitus (coarser): (4)

Answer 17

- occurs with the presence of a solid mass or fluids
1- tumor
2- lung consolidation
3- heavy bronchial secretions
4- compressed lung

Question 18

What would you expect to see in an obstructive retraction?

Answer 18

• In one of the bronchi (MC Right 2/2 to its broader lumen and more vertical placement)
• U/L retraction
• no suprasternal notch involvement

Question 19

T/F: the trachea has a normal crepitus feeling with palpation

Answer 19

True

Question 20

Crepitus indicates:

Answer 20

Air in the subQ tissues

Question 21

Coarse, grating vibration associated w/ inspiration (inflammation of the pleural surfaces)

Answer 21

Pleural friction rub