Assessment of the Respiratory System

Question 1

Complete examination of the thorax and lungs consists of ___________________________________________________________ of the posterior and anterior thorax to evaluate functioning of the lungs.

Answer 1

history taking, inspection, palpation, percussion, and auscultation

Question 2

Complete examination of the thorax and lungs consists of history taking, inspection, palpation, percussion, and auscultation of the _______________________________ to evaluate functioning of the lungs.

Answer 2

posterior and anterior thorax

Question 3

Difficulty breathing

Answer 3

Wheezing

Question 4

a mixture of saliva and mucus coughed up from the respiratory tract, typically as a result of infection or other disease and often examined microscopically to aid medical diagnosis.

Answer 4

sputum

Question 5

cough acute

Answer 5

3 weeks

Question 6

lasting 3 to 8 weeks

Answer 6

subacute (cough)

Question 7

more than 8 weeks

Answer 7

chronic (cough)

Question 8

coughing up blood from some part of the lungs

Answer 8

hemoptysis

Question 9

A clenched fist over the sternum (Levine sign)

Answer 9

angina pectoris

Question 10

a finger pointing to a tender spot on the chest wall

Answer 10

musculoskeletal pain

Question 11

a hand moving from the neck to the epigastrium

Answer 11

heartburn

Question 12

defined as breathing cessation for ≥10 seconds

Answer 12

apneas

Question 13

These symptoms, especially daytime sleepiness and snoring, are hallmarks of

Answer 13

obstructive sleep apnea

Question 14

Commonly seen in patients with obesity, posterior malocclusion of the jaw (retrognathia), treatment-resistant hypertension, heart failure, atrial fibrillation, stroke, and type 2 diabetes.

Answer 14

obstructive sleep apnea

Question 15

for needle insertion for tension pneumothorax

Answer 15

2nd intercostal space

Question 16

2nd intercostal space for needle insertion for

Answer 16

tension pneumothorax

Question 17

for chest tube insertion

Answer 17

4th intercostal space

Question 18

4th intercostal space for

Answer 18

chest tube insertion

Question 19

for the lower margin of an endotracheal tube on a chest x-ray

Answer 19

T4

Question 20

T4 for the lower margin of an

Answer 20

endotracheal tube on a chest x-ray

Question 21

symptoms for tension pneumothorax may include

Answer 21

• chest pain
• shortness of breath
• rapid heart rate
• shallow breathing
• anxiety
• blue or ashen skin

Question 22

a landmark for thoracentasis with needle insertion immediately superior to the 8th rib

Answer 22

T7-T8 intercostal space

Question 23

is more common in the right middle and lower lobe because the right main bronchus is more vertical

Answer 23

aspiration pneumonia

Question 24

aspiration pneumonia is more common in the _______________________ because the right main bronchus is more vertical

Answer 24

right middle and lower lobe

Question 25

Palpate for __________________ using the ball or ulnar edge of one hand while the client says “ninety-nine”.

Answer 25

fremitus

Question 26

Palpate for fremitus, using the ______________________________ while the client says “ninety-nine”.

Answer 26

ball or ulnar edge of one hand

Question 27

Palpate for fremitus, using the ball or ulnar edge of one hand while the client says “__________________”.

Answer 27

ninety-nine

Question 28

Palpate for chest expansion. Place hands on the posterior chest wall with ____________________________________, and observe the movement of your thumbs as the client takes a deep breath

Answer 28

your thumbs at the level of T9 or T10

Question 29

note that the _______________________________ are not touching the chest wall

Answer 29

thumb and 2nd, 4th and 5th fingers

Question 30

is the most important examination technique for assessing air flow through the tracheobronchial tree.

Answer 30

Auscultation

Question 31

Before beginning auscultation, ask the patient to cough once or twice to clear _______________________ that can produce unimportant extra sounds

Answer 31

mild atelectasis or airway mucus

Question 32

If “ee” sounds like “A” and has a nasal bleating quality, an E-to-A change, or __________________, is present.

Answer 32

egophony

Question 33

ask the client to repeat the phrase “ninety-nine”

Answer 33

bronchophony

Question 33

ask the client to repeat the letter “E”

Answer 33

egophony

Question 34

Normally the sounds transmitted through the chest wall are muffled and indistinct. Louder voice sounds are called ________________________.

Answer 34

bronchophony

Question 35

ask the client to whisper the phrase “onetwo-three” or “ninety-nine”

Answer 35

whisper pectoriloquy

Question 36

Louder, clearer whispered sounds are called

Answer 36

whispered pectoriloquy

Question 37

ratio of anteroposterior diameter to transverse diameter

Answer 37

normally 1:2

Question 38

curvature of the spine (anterior/posterior)

Answer 38

Kyphosis

Question 39

curvature of the spine (lateral)

Answer 39

Scoliosis

Question 40

increased anterior/posterior chest wall

Answer 40

Barrel Chest

Question 41

Abnormal spinal curvatures and vertebral rotation deform the chest. Distortion of the underlying lungs may make interpretation of lung findings very difficult.

Answer 41

Thoracic Kyphoscoliosis

Question 42

The lateral diameter of the thorax in the normal adult is greater than its AP diameter. The ratio of its AP diameter to the lateral diameter is normally ∼0.7 up to 0.9 and increases with aging

Answer 42

Normal Adult

Question 43

There is an increased AP diameter. This shape is normal during infancy, and often accompanies aging and chronic obstructive pulmonary disease.

Answer 43

Barrel Chest

Question 44

Note depression in the lower portion of the sternum. Compression of the heart and great vessels may cause murmurs.

Answer 44

Funnel Chest (Pectus Excavatum)

Question 45

The sternum is displaced anteriorly, increasing the AP diameter. The costal cartilages adjacent to the protruding sternum are depressed.

Answer 45

Pigeon Chest (Pectus Carinatum)

Question 46

SIGNS OF RESPIRATORY DISTRESS

Answer 46

▪ Tachypneic (>25/bpm) ▪Cyanosis (hypoxia) or pallor (heart failure) ▪ Pursed-lip breathing ▪ Accessory muscle use ▪ Diaphragmatic paradox ▪ Intercostal indrawing

Question 47

Accessory muscles of ventilation:

Answer 47

1. scalene 2. sternocleidomastoid 3. pectoralis major 4. trapezius 5. external intercostals

Question 48

- Inspiratory sounds last longer than expiratory sounds. - Soft - Relatively low - Over most of both lungs

Answer 48

Vesicular

Question 49

- Inspiratory and expiratory sounds are almost equal. - Intermediate - Intermediate - Often in the 1st and 2nd interspaces anteriorly and between the scapulae

Answer 49

Bronchovesicular

Question 50

- Expiratory sounds last longer than inspiratory ones - Loud - Relatively high - Over the manubrium, (larger proximal airways)

Answer 50

Bronchial

Question 51

- Inspiratory and expiratory sounds are almost equal. - Very loud - Relatively high - Over the trachea in the neck

Answer 51

Tracheal

Question 52

- Intermittent, nonmusical, and brief - Like dots in time

Answer 52

Crackles (or Rales)

Question 53

soft, high-pitched (∼650 Hz), very brief (5–10 ms)

Answer 53

Fine crackles

Question 54

somewhat louder, lower in pitch (∼350 Hz), brief (15–30 ms)

Answer 54

Coarse crackles

Question 55

- Sinusoidal, musical, prolonged (but not necessarily persisting throughout the respiratory cycle) - Like dashes in time

Answer 55

Wheezes and Rhonchi

Question 56

relatively high-pitched (≥400 Hz) with hissing or shrill quality (>80 ms)

Answer 56

Wheezes

Question 57

relatively low-pitched (150–200 Hz) with snoring quality (>80 ms)

Answer 57

Rhonchi

Question 58

is a continuous, high-frequency, high-pitched musical sound produced during airflow through a narrowing in the upper respiratory tract.

Answer 58

Stridor

Question 59

is best heard over the neck during inspiration, but can be biphasic. Causes of the underlying airway obstruction include tracheal stenosis from intubation, airway edema after device removal, epiglottitis, foreign body, and anaphylaxis. Immediate intervention is warranted

Answer 59

Stridor

Question 60

is a discontinuous, low-frequency, grating sound that arises from inflammation and roughening of the visceral pleura as it slides against the parietal pleura. This nonmusical sound is biphasic, heard during inspiration and expiration, and often best heard in the axilla and base of the lungs

Answer 60

Pleural Rub

Question 61

Before beginning auscultation, ask the patient to ________________________ to clear mild atelectasis or airway mucus that can produce unimportant extra sounds.

Answer 61

cough once or twice

Question 62

Normally the sounds transmitted through the chest wall are _____________________

Answer 62

muffled and indistinct

Question 63

Localized bronchophony and egophony are seen in lobar consolidation from

Answer 63

pneumonia

Question 64

In patients with fever and cough, the presence of bronchial breath sounds and egophony more than triples the likelihood of

Answer 64

pneumonia

Question 65

The lateral diameter of the thorax in the normal adult is greater than its AP diameter. The ratio of its AP diameter to the lateral diameter is normally ________________________________________

Answer 65

∼0.7 up to 0.9 and increases with aging.

Question 66

stridor is best heard over?

Answer 66

over the neck during inspiration

Question 67

pleural rub is heard during and best heard in?

Answer 67

heard during inspiration and expiration; best heard in the axilla and base of the lungs