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Mental status > ch 19 jarvis Thorax and lungs > Flashcards

ch 19 jarvis Thorax and lungs Flashcards

1
Q

a musculotendinous septum that separates the thoracic cavity from the abdomen.

A

diaphragm

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2
Q

is a bony structure with a conical shape, which is narrower at the top (

A

thoracic cage

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3
Q

are the points at which the ribs join their cartilages. They are not palpable

A

costochondral junctions

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4
Q

b/w clavicles

A

Suprasternal Notch

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5
Q

“breastbone” has three parts:

A

the manubrium, the body, and the xiphoid process.

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6
Q

, this is the articulation of the manubrium and body of the sternum, and it is continuous with the 2nd rib

A

angle of Louis

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7
Q

is the middle section of the thoracic cavity containing the esophagus, trachea, heart, and great vessels

A

mediastinum

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8
Q

anterior chest is 3 or 4 cm above the inner third of the clavicles

A

apex/apices of lungs

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9
Q

rests on the diaphragm at about the 6th rib in the midclavicular line

A

base, or lower border of lungs

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10
Q

T10 usually corresponds to the

A

base of lungs Posteriorly

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11
Q

the location of C7 marks the

A

apex of lung tissue Posteriorly

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12
Q

right lung is shorter than the left lung because of the

A

underlying liver

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13
Q

is narrower than the right lung because the heart bulges to the left

A

left lung

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14
Q

right lung has three lobes, and the left lung has two lobes

A

lobes in lungs

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15
Q

also contains the horizontal (minor) fissure, which divides the right upper and middle lobes

A

right lung

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16
Q

upper lobes occupy a smaller band of tissue from their apices at T1 down to T3 or T4.

A

posterior upper lobes

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17
Q

is that it is almost all lower lobe

A

posterior chest

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18
Q

level of T10 on expiration and T12 on inspiration

A

on inspiration lower lobe reaches

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19
Q

Laterally lung tissue extends from the apex of the axilla down to the

A

7th or 8th rib

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20
Q

extends from the apex of the axilla down to the 5th rib at the midaxillary line

A

left upper lobe

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21
Q

continues down to the 8th rib in the midaxillary line.

A

left lower lobe

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22
Q
  1. left lung has no middle lobe.
  2. The anterior chest contains mostly upper and middle lobe with very little lower lobe.
  3. The posterior chest contains almost all lower lobe.
A

three points that commonly confuse beginning examiners:

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23
Q

are serous membranes that form an envelope between the lungs and the chest wall

A

pleurae

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24
Q

lines the outside of the lungs, dipping down into the fissures

A

visceral pleura

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25
Q

lining the inside of the chest wall and diaphragm.

A

parietal pleura

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26
Q

lies anterior to the esophagus and is 10 to 11 cm long in the adult. It begins at the level of the cricoid cartilage in the neck and bifurcates just below the sternal angle into the right and left main bronchi

A

trachea

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27
Q

right main bronchus is shorter, wider, and more vertical than the left main bronchus.

A

difference b/w bronchus

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28
Q

transport gases between the environment and the lung parenchyma
-constitute the dead space, or space that is filled with air but is not available for gaseous exchange

A

trachea and bronchi

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29
Q

is a functional respiratory unit that consists of the bronchioles, alveolar ducts, alveolar sacs, and the alveoli

A

acinus

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30
Q

four major functions of the respiratory system:

A

(1) supplying oxygen to the body for energy production; (2) removing carbon dioxide as a waste product of energy reactions;
(3) maintaining homeostasis (acid-base balance) of arterial blood;
(4) maintaining heat exchange (less important in humans).

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31
Q

(slow, shallow breathing) causes carbon dioxide to build up in the blood

A

Hypoventilation

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32
Q

(rapid, deep breathing) causes carbon dioxide to be blown off.

A

hyperventilation

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33
Q

brainstem (pons and medulla)

A

involuntary control of respiration

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34
Q

the change in carbon dioxide and oxygen levels in the blood and, less important, the hydrogen ion level

A

major feedback loop is humoral regulation

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35
Q

increase of carbon dioxide in the blood, or

A

hypercapnia

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36
Q

decrease of oxygen in the blood

A

(hypoxemia)

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37
Q

(1) the vertical diameter lengthens or shortens, which is accomplished by downward or upward movement of the diaphragm;
(2) the anteroposterior (AP) diameter increases or decreases, which is accomplished by elevation or depression of the ribs

A

mechanical expansion and contraction of the chest cavity alters the size of the thoracic container in two dimensions:

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38
Q

inspiration increasing the size of the thoracic container creates a slightly

A

negative pressure

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39
Q

during expiration

A

positive pressure within the alveoli, and the air flows out

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40
Q

are the sternomastoids, the scaleni, and the trapezii

A

neck muscles

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41
Q

of fetal life the primitive lung bud emerges

A

first 5 weeks (infant lungs)

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42
Q

the conducting airways reach the same number as in the adult

A

16 weeks (3 months) (infant lungs)

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43
Q

surfactant, the complex lipid substance needed for sustained inflation of the air sacs, is present in adequate amounts

A

32 weeks (8 months) (infant lungs)

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44
Q

baby’s body systems all develop in utero, but the respiratory system alone does not function until

A

birth

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45
Q

After birth, SHS exposure increases the infant’s risk of upper and lower respiratory tract infections, otitis media, asthma, tooth decay, hearing loss, and metabolic syndrome, as well as later risks for attention-deficit/hyperactivity disorder, behavioral disorders, learning disabilities, cognitive disabilities, and problems at school.6 It is crucial for pregnant women and infants and children to avoid SHS

A

second hand smoke risks for infants

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46
Q

(pregnant woman) enlarging uterus elevates the diaphragm >decreases the vertical diameter of the thoracic cage> increase horizontal diameter
- total circumference of the chest cage increases by 6 cm

A

4 cm during pregnancy

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47
Q

affects close to 75% of women; does not alter activities of daily living; and is not associated with cough, wheezing, or exercise

A

physiologic dyspnea (pregnancy)

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48
Q

costal cartilages become calcified; thus the thorax is less mobile
-respiratory muscle declines

A

Aging adult

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49
Q

decrease in elastic properties within the lungs, making them less distensible and lessening their tendency to collapse and recoil

A

Aging adult

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50
Q

changes increase small airway closure, which yields a decreased vital capacity and increased residual volume

A

Aging adult

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51
Q

(the maximum amount of air that a person can expel from the lungs after first filling the lungs to maximum)

A

decreased vital capacity

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52
Q

(the amount of air remaining in the lungs even after the most forceful expiration).

A

increased residual volume

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53
Q

histologic changes (i.e., a gradual loss of intra-alveolar septa and a decreased number of alveoli) also occur= less gas exchange

A

Aging adult

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54
Q

Acute cough lasts

A

less than 2 or 3 weeks

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55
Q

chronic cough lasts

A

over 2 months.

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56
Q

continuous cough throughout day—

A

acute illness (e.g., respiratory infection)

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57
Q

afternoon/evening cough—

A

may be exposure to irritants at work

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58
Q

night cough—

A

postnasal drip, sinusitis;

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59
Q

early morning cough—

A

chronic bronchial inflammation of smokers.

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60
Q

white or clear mucoid—sputum

A

colds, bronchitis, viral infections

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61
Q

yellow or green sputum—

A

bacterial infections

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62
Q

rust colored sputum—

A

TB, pneumococcal pneumonia

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63
Q

pink, frothy sputum—

A

pulmonary edema, some sympathomimetic medications have a side effect of pink-tinged mucus.

64
Q

mycoplasma pneumonia—

A

hacking cough

65
Q

early heart failure—

A

dry cough

66
Q

colds, bronchitis, pneumonia—

A

congested.

67
Q

is SOB lasting >1 month and may have neurogenic, respiratory, or cardiac origin. It also occurs with anemia, anxiety, and deconditioning

A

Chronic dyspnea

68
Q

often described as “chest tightness

A

Asthma attack

69
Q

Traffic-related air pollution increases risk of

A

allergic rhinitis and asthma

70
Q

may be at risk for grain or pesticide inhalation

A

Farmers

71
Q

rural Midwest have risk for ;

A

histoplasmosis exposure (fungus infection from soil)

72
Q

Coal miners have risk for

A

pneumoconiosis

73
Q

Stone cutters, miners, and potters have risk for

A

silicosis

74
Q

include. chronic bronchitis or emphysema (or both)

A

COPD

75
Q

spirometry testing to confirm the diagnosis of COPD.

A

18 points or less= risk for COPD

76
Q

anteroposterior (AP) diameter should be less than the transverse diameter

A

ratio of AP to transverse diameter is about 0.70 to 0.75 in adults, and it increases with age

77
Q

is a palpable vibration

A

Fremitus

78
Q

is most prominent between the scapulae and around the sternum, sites where the major bronchi are closest to the chest wall

A

Fremitus

79
Q

is palpable with inflammation of the pleura

A

Pleural friction fremitus

80
Q

is palpable with thick bronchial secretions

A

Rhonchal fremitus

81
Q

occurs with compression or consolidation of lung tissue (e.g., lobar pneumonia). This is present only when the bronchus is patent and the consolidation extends to the lung surface.

A

Increased fremitus

82
Q

occurs with obstructed bronchus, pleural effusion or thickening, pneumothorax, or emphysema. Any barrier that comes between the sound and your palpating hand decreases fremitus

A

Decreased fremitus

83
Q

is a coarse, crackling sensation palpable over the skin surface. It occurs in subcutaneous emphysema when air escapes from the lung and enters the subcutaneous tissue, as after open thoracic injury or surgery.

A

Crepitus

84
Q

is the low-pitched, clear, hollow sound that predominates in healthy lung tissue in the adult

A

Resonance

85
Q

is a lower-pitched, booming sound found when too much air is present such as in emphysema or pneumothorax

A

Hyperresonance

86
Q

(soft, muffled thud) signals abnormal density in the lungs, as with pneumonia, pleural effusion, atelectasis, or tumor

A

dull note

87
Q

technique of measuring diaphragmatic excursion using percussion is no longer recommended for two reasons:

A

(1) in persons with lung disease, evidence shows that clinicians usually overestimate diaphragmatic movement and that their results differ from chest image by 1 to 3 cm; and
(2) evidence shows that diaphragmatic excursion of <2 cm is an unreliable and infrequent sign of COPD.

88
Q

three types of normal breath sounds in the adult and older child:

A

bronchial (sometimes called tracheal or tubular), bronchovesicular, and vesicular.

89
Q
  • pitch- high
  • amplitude- loud
  • Duration- inspiration< expiration
  • Quality- harsh, hollow tubular
  • normal location- Trachea and larynx
A

BRONCHIAL (TRACHEAL)

90
Q
  • pitch- Moderate
  • amplitude- Moderate
  • Duration- Inspiration = expiration
  • Quality- Mixed
  • normal location- Over major bronchi where fewer alveoli are located: posterior, between scapulae especially on right; anterior, around upper sternum in 1st and 2nd intercostal spaces
A

BRONCHOVESICULAR

91
Q
  • pitch- Low
  • amplitude- Soft
  • Duration- inspiration> expiration
  • Quality- Rustling, like the sound of the wind in the trees
  • normal location- Over peripheral lung fields where air flows through smaller bronchioles and alveoli
A

VESICULAR

92
Q

are discontinuous popping sounds heard over inspiration

A

Crackles

93
Q

are continuous musical sounds heard mainly over expiration

A

wheezes

94
Q

are short, popping, crackling sounds that last only a few breaths (not pathologic)

  • sections of alveoli are not fully aerated (as in sleepers or in older adults), they deflate slightly and accumulate secretions.
  • heard only in peripherally
A

Atelectatic crackles

95
Q

transmission is soft, muffled, and indistinct

A

Normal voice

96
Q

Consolidation or compression of lung tissue will

A

enhance the voice sounds, making the words more distinct.

97
Q

has horizontal ribs and costal angle >90 degrees.

A

Barrel chest

98
Q

Hypertrophy of abdominal muscles

A

chronic emphysema.

99
Q

Tense, strained, tired facies and purse-lipped breathing (the lips in a whistling position)

  • Clubbing of distal phalanx
  • Rectus abdominis and internal intercostal muscles (expiration)
A

accompany COPD

100
Q

may be reflected by excessive drowsiness or anxiety, restlessness, and irritability.

A

Cerebral hypoxia

101
Q

Cutaneous angiomas (spider nevi) aka cherry angiomas

A

associated with liver disease

102
Q

occurs when part of the lung is obstructed (pneumonia) or collapsed or when guarding to avoid postoperative or pleurisy pain.

A

Unequal chest expansion

103
Q

suggests obstruction of respiratory tract or that increased inspiratory effort is needed, as with atelectasis

A

Retraction (inspiration)

104
Q

Bulging indicates trapped air as in the forced expiration associated with

A

emphysema or asthma (interspaces)

105
Q

very heavy exercise the accessory neck muscles (scalene, sternomastoid, trapezius) are used momentarily to

A

enhance inspiration

106
Q

is the number of seconds it takes for the person to exhale from total lung capacity to residual volume
-6 seconds or more occurs with obstructive lung disease

A

forced expiratory time

107
Q

forced vital capacity (FVC) is the total volume of air exhaled. The forced expiratory volume in 1 second (FEV1) is the volume exhaled in the first measured second
-FEV1/FVC ratio of 75% or greater, meaning that no significant obstruction of airflow is present.

A

handheld spirometer measures lung health in chronic conditions such as asthma

108
Q

> 300 meters in 6 minutes is more likely to engage in activities of daily living.

A

6-minute walk test (6 MWT) is a safer, simple, inexpensive, clinical measure of functional status in aging adults

109
Q

By age ? years the thorax reaches the adult ratio of 1 : 2 (AP–to-transverse diameter)
-2 years head and chest are equal.

A

6 yrs

110
Q

barrel shape persisting after age 6 years, which may develop with

A

chronic asthma or cystic fibrosis. (infant)

111
Q

Apgar scoring system to measure the successful transition to extrauterine life infNT (respiratory response)

A

five standard parameters are scored at 1 minute and 5 minutes after birth
-1-minute Apgar with a total score of 7 to 10 indicates a newborn in good condition

112
Q

0 to 2 indicates a severely depressed newborn needing full resuscitation, ventilatory assistance, and subsequent intensive care

A

Apgar scoring system to measure the successful transition to extrauterine life infNT (respiratory response)

113
Q

1-minute Apgar with a total score of 3 to 6 indicates a moderately depressed newborn needing more resuscitation and subsequent close observation

A

Apgar scoring system to measure the successful transition to extrauterine life infNT (respiratory response)

114
Q

infant breathes through the

A

nose rather than the mouth and is an obligate nose breather until 3 months

115
Q

Slight flaring of the lower costal margins may occur with respirations, but normally no flaring of the nostrils and no sternal retractions or intercostal retractions occur. The diaphragm is the newborn’s major respiratory muscle. Intercostal muscles are not well developed. Thus you observe the abdomen bulge with each inspiration but see little thoracic expansion.

A

infants respiratory development

116
Q

(infants) Marked retractions of sternum and intercostal muscles indicate increased inspiratory effort, as in

A

atelectasis, pneumonia, asthma, and acute airway obstruction.

117
Q

infant tachypnea of 50 to 100 breaths/min during sleep may be an early sign of

A

heart failure.

118
Q

Brief periods of apnea less than 10 to 15 seconds are

A

common in infants

119
Q

periodic breathing is more common in

A

premature infants.

120
Q

Asymmetric expansion occurs with

A

diaphragmatic hernia or pneumothorax (infants)

121
Q

Crackles only in upper lung fields occur with

A

cystic fibrosis (infants)

122
Q

crackles only in lower lung fields occur with

A

heart failure.(infants)

123
Q

is a high-pitched inspiratory crowing sound heard without the stethoscope, occurring with upper airway obstruction (e.g., croup, foreign body aspiration, or acute epiglottitis).

A

Stridor

124
Q

Persistent peristaltic sounds with diminished breath sounds on the same side may indicate

A

diaphragmatic hernia (infants)

125
Q

occurs with lower airway obstruction (e.g., asthma or bronchiolitis). When unilateral, it may be foreign body aspiration

A

Expiratory wheezing (infants)

126
Q

thoracic cage appears wider, and the costal angle widens by about 50%. Respirations are deeper, with a 40% increase in tidal volume.

A

pregnant woman

127
Q

chest cage commonly shows an increased AP diameter, giving a round barrel shape and kyphosis or an outward curvature of the thoracic spine

A

Agining adult

128
Q

is the smoke seen from the burning end of a tobacco product

A

Sidestream smoke

129
Q

is the smoke exhaled from the person smoking

A

mainstream smoke

130
Q

thorax has an elliptical shape with an anteroposterior-to-transverse diameter documented as 1 : 2 or 0.70.

A

Normal Adult (for Comparison) (thorax)

131
Q

equal AP-to-transverse diameter and that ribs are horizontal instead of the normal downward slope. This is associated with normal aging and also with chronic emphysema and asthma as a result of hyperinflation of lungs.

A

Barrel Chest(thorax)

132
Q

markedly sunken sternum and adjacent cartilages (also called funnel breast). Depression begins at second intercostal space, becoming depressed most at junction of xiphoid with body of sternum. More noticeable on inspiration. Congenital, usually not symptomatic. When severe, sternal depression may cause embarrassment and a negative self-concept. Surgery may be indicated

A

Pectus Excavatum(thorax)

133
Q

forward protrusion of the sternum, with ribs sloping back at either side and vertical depressions along costochondral junctions (pigeon breast). Less common than pectus excavatum, this minor deformity requires no treatment. If severe, surgery may be indicated.

A

Pectus Carinatum(thorax)

134
Q

lateral S-shaped curvature of the thoracic and lumbar spine, usually with involved vertebrae rotation. Note unequal shoulder and scapular height and unequal hip levels, rib interspaces flared on convex side. More prevalent in adolescent age-groups, especially girls. Mild deformities are asymptomatic. If severe (>45 degrees) deviation is present, scoliosis may reduce lung volume, and person is at risk for impaired cardiopulmonary function. Primary impairment is cosmetic deformity, negatively affecting self-image

A

Scoliosis(thorax)

135
Q

exaggerated posterior curvature of the thoracic spine (humpback) that causes significant back pain and limited mobility. Severe deformities impair cardiopulmonary function. If the neck muscles are strong, compensation occurs by hyperextension of head to maintain level of vision.
Kyphosis is associated with aging, especially the “dowager’s hump” of postmenopausal osteoporotic women. However, it is common well before menopause. Women with adequate exercise habits are less likely to have kyphosis.

A

Kyphosis(thorax)

136
Q

Occasional sighs punctuate the normal breathing pattern and are purposeful to expand alveoli. Frequent sighs may indicate emotional dysfunction and also may lead to hyperventilation and dizziness.

A

Sigh (Respiratory Patterns)

137
Q

Rapid, shallow breathing. Increased rate, >24 per minute. This is a normal response to fever, fear, or exercise. Rate also increases with respiratory insufficiency, pneumonia, alkalosis, pleurisy, and lesions in the pons

A

Tachypnea (Respiratory Patterns)

138
Q

Increase in both rate and depth. Normally occurs with extreme exertion, fear, or anxiety. Also occurs with diabetic ketoacidosis (Kussmaul respirations), hepatic coma, salicylate overdose (producing a respiratory alkalosis to compensate for the metabolic acidosis), lesions of the midbrain, and alteration in blood gas concentration (either an increase in CO2 or a decrease in oxygen). Hyperventilation blows off CO2, causing a decreased level in the blood (alkalosis).

A

Hyperventilation (Respiratory Patterns)

139
Q

Slow breathing. A decreased but regular rate (<10 per minute), as in drug-induced depression of the respiratory center in the medulla, increased intracranial pressure, and diabetic coma.

A

Bradypnea (Respiratory Patterns)

140
Q

irregular shallow pattern caused by an overdose of narcotics or anesthetics. May also occur with prolonged bed rest or conscious splinting of the chest to avoid respiratory pain

A

Hypoventilation(Respiratory Patterns)

141
Q

cycle in which respirations gradually wax and wane in a regular pattern, increasing in rate and depth and then decreasing. The breathing periods last 30 to 45 seconds, with periods of apnea (20 seconds) alternating the cycle. The most common cause is severe heart failure; other causes are renal failure, meningitis, drug overdose, and increased intracranial pressure. Occurs normally in infants and older adults during sleep

A

Cheyne-Stokes Respiration(Respiratory Patterns)

142
Q

Similar to Cheyne-Stokes respiration, except that the pattern is irregular. A series of normal respirations (3 to 4) is followed by a period of apnea. The cycle length is variable, lasting anywhere from 10 seconds to 1 minute. Seen with head trauma, brain abscess, heat stroke, spinal meningitis, and encephalitis.

A

Biot Respiration(Respiratory Patterns)

143
Q

Normal inspiration and prolonged expiration to overcome increased airway resistance. In a person with chronic obstructive lung disease, any situation calling for increased heart rate (exercise) may lead to dyspneic episode (air trapping) because the person does not have enough time for full expiration.

A

Chronic Obstructive Breathing(Respiratory Patterns)

144
Q

Occurs with conditions that increase the density of lung tissue, thereby making a better conducting medium for vibrations (e.g., compression or consolidation [pneumonia]). There must be a patent bronchus, and consolidation must extend to lung surface for increased fremitus to be apparent.

A

Increased Tactile Fremitus (

Abnormal Tactile Fremitus)

145
Q

Occurs when anything obstructs transmission of vibrations (e.g., an obstructed bronchus, pleural effusion or thickening, pneumothorax, and emphysema). Any barrier that gets in the way of the sound and your palpating hand decreases fremitus.

A

Decreased Tactile Fremitus(Abnormal Tactile Fremitus)

146
Q

Vibration felt when inhaled air passes through thick secretions in the larger bronchi. This may decrease somewhat by coughing

A

Rhonchal Fremitus(Abnormal Tactile Fremitus)

147
Q

Produced when inflammation of the parietal or visceral pleura causes a decrease in the normal lubricating fluid. The opposing surfaces make a coarse grating sound when rubbed together during breathing. This sound is best detected by auscultation, but it may be palpable and feels like two pieces of leather grating together. It is synchronous with respiratory excursion. Also called a palpable friction rub.

A

Pleural Friction Fremitus (Abnormal Tactile Fremitus)

148
Q

Discontinuous, high-pitched, short crackling, popping sounds heard during inspiration that are not cleared by coughing; you can simulate this sound by rolling a strand of hair between your fingers near your ear or by moistening your thumb and index finger and separating them near your ear
MECHANISM: Inspiratory crackles: inhaled air collides with previously deflated airways; airways suddenly pop open, creating explosive crackling sound
Expiratory crackles: sudden airway closing
-noticed with pneumonia, bronchiolitis, or atelectasis, new born.

A

Crackles—Fine (formerly called rales)// discontinuous sounds

149
Q

Loud, low-pitched bubbling and gurgling sounds that start in early inspiration and may be present in expiration; may decrease somewhat by suctioning or coughing but reappear shortly—sounds like opening a Velcro fastener
MECHANISM:Inhaled air collides with secretions in the trachea and large bronchi

A

Crackles——Coarse(formerly called rales)// discontinuous sounds

150
Q

Sound like fine crackles but do not last and are not pathologic; disappear after the first few breaths; heard in axillae and bases (usually dependent) of lungs
MECHANISM: When sections of alveoli are not fully aerated, they deflate and accumulate secretions; crackles are heard when these sections reexpand with a few deep breaths

A

Atelectatic crackles// discontinuous sounds

151
Q

A very superficial sound that is coarse and low pitched; it has a grating quality as if two pieces of leather are being rubbed together; sounds just like crackles, but close to the ear; sounds louder if you push the stethoscope harder onto the chest wall; sound is inspiratory and expiratory

A

Pleural friction rub// discontinuous sounds

152
Q

High-pitched, musical squeaking sounds that sound polyphonic (multiple notes as in a musical chord); predominate in expiration but may occur in both expiration and inspiration
-Diffuse airway obstruction from acute asthma or chronic emphysema

A

Wheeze—High-pitched (sibilant)(Continuous Sounds)

153
Q

Low-pitched; monophonic, single note, musical snoring, moaning sounds; they are heard throughout the cycle, although they are more prominent on expiration; may clear somewhat by coughing
-Bronchitis, single bronchus obstruction from airway tumo

A

Wheeze—Low-pitched (sonorous rhonchi)//Continuous Sounds)

154
Q

High-pitched, monophonic, inspiratory, crowing sound; louder in neck than over chest wall
-Croup and acute epiglottitis in children and foreign inhalation; obstructed airway may be life-threatening

A

Stridor/Continuous Sounds)

155
Q

Auscultate the chest while the person phonates a long “ee-ee-ee-ee” sound
-Over area of consolidation or compression the spoken “eeee” sound changes to a bleating long “aaaaa” sound

A

Egophony

156
Q

Ask the person to whisper a phrase such as “one-two-three” as you auscultate
- normal response is faint, muffled, and almost inaudible

A

Whispered Pectoriloquy

157
Q

Ask the person to repeat “ninety-nine” while you listen with the stethoscope over the chest wall; listen especially if you suspect pathology
-Normal voice transmission is soft, muffled, and indistinct; you can hear sound through the stethoscope but cannot distinguish exactly what is being said

A

Bronchophony

Mental status (69 decks)

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