Chest

Question 1

What area corresponds to the second rib?

Answer 1

manubriosternal junction - angle of louis

Question 2

Who has chest that are AP=transverse in size?

Answer 2

infants

Question 3

What is SOB with sitting up?

Answer 3

platypnea

Question 4

What causes barrel chest in geriatrics?

Answer 4

loss of muscle strength, losee of lung resiliency

Question 5

What are symptoms that mean chest pain is not from the heart?

Answer 5

There is a constant achiness that lasts all day.
It does not radiate.
It is made worse by pressing on the chest wall.
It is a fleeting, needle-like jab that lasts only a few seconds.
It is situated in the shoulders or between the shoulder blades in the back.
Think of the heart but, importantly, in such circumstances, also think of other possibilities in the chest

Question 6

What family hx do you want for chest/lung complaint?

Answer 6

Tuberculosis 
 Cystic fibrosis 
 Emphysema 
 	Allergy, asthma, atopic dermatitis 
 Malignancy 
 Bronchiectasis 
 Bronchitis 
 Clotting disorders (risk of pulmonary embolism)

Question 7

How do you calculate pack year?

Answer 7

Number of years of smoking X Number of packs smoked per day

Question 8

What is in india, indonesia, south africa, nigeria?

Answer 8

TB

Question 9

What is in midwest?

Answer 9

histo

Question 10

What is in southwest?

Answer 10

coccidioidmycosis

Question 11

What is in southwest asia, africa, caribbean?

Answer 11

schistosomiasis

Question 12

What is a life threatening emergency that occurs when sternum or rib fractures, becoming detached from the rest of the chest and causing loss of stability of the thoracic cage. Can cause respiratory failure?

Answer 12

flail chest

Question 13

What is the normal resp rate?

Answer 13

10-14/min up to 20

Question 14

What is SOB when lying down?

Answer 14

orthopnea

Question 15

Regular and comfortable at a rate of 12-20

Answer 15

normal

Question 16

slower than 12 breaths per min

Answer 16

bradypnea

Question 17

faster than 20 breaths per min

Answer 17

tachypnea

Question 18

faster than 20/min, deep breathing

Answer 18

hyperventilation

Question 19

freuqently interspersed deeper breaths

Answer 19

sighing

Question 20

increasing difficulty getting breath out?

Answer 20

air trapping

Question 21

varying peroids of increasing depth interspersed with apnea

Answer 21

cheyne-stokes

Question 22

rapid, deep, labored

Answer 22

kussmaul

Question 23

irregularly interspersed peroids of apnea in disorganized sequence of breaths

Answer 23

biot

Question 24

significant disorganized with irregular varying depths of respiration

Answer 24

ataxic

Question 25

What causes an increase in resp?

Answer 25

acidosis, CNS lesion (pons), anxiety, aspirin poisoning, oxygen need (hypoxemia), pain

Question 26

What causes decrease in resp?

Answer 26

alkalosis, CNS (cerebrum), MG, narcotic overdoses, obesity

Question 27

What would the breathing be like for a cerebral brain damage pt?

Answer 27

cheyne stokes resp

Question 28

What are peripheral clues to CV/pulm issues?

Answer 28

``` Cyanosis of lips and nails especially Breath - malodorous Lips – pursed Nares - flared Nails – clubbing ```

Question 29

What does ammonia breath mean?

Answer 29

uremia

Question 30

What is the normal costal angle?

Answer 30

90

Question 31

Where is tactile fremitus best felt?

Answer 31

bifurcation of bronchi

Question 32

What contracts on inspiration?

Answer 32

SCM

Question 33

What retracts on inspiration

Answer 33

clavicule, intercostals

Question 34

When is costal angle widened?

Answer 34

pregnancy

Question 35

Where does the examiner percuss for diaphragmatic excusion?

Answer 35

scapular line

Question 36

What are low intensity sounds heard over healthy lung fields?

Answer 36

vesicular

Question 37

What breath sounds are heard over trachea, are high intensity and pitch?

Answer 37

bronchial

Question 38

What is rales now called?

Answer 38

crackles

Question 39

In what position is the hammans sign best heard?

Answer 39

LLD

Question 40

What can cause deviation of trachea away from affected side?

Answer 40

thyroid enlargment, pleural effusion

Question 41

What way does the trachea deviate in pneumothorax?

Answer 41

either

Question 42

: a crackly or crinkly sensation, a gentle, bubbly feeling, rubbing hair next to the ear, or sound when Velcro is pulled apart.

Answer 42

Crackles

Question 43

caused by inflammation of the pleural surfaces. Think of it as the feel of leather rubbing on leather.

Answer 43

pleural friction rub

Question 44

mucous moving through airways (simple congestion), or with plugging

Answer 44

rhonchi

Question 45

air in the subcutaneous tissue from a rupture somewhere in the respiratory system or by infection with a gas-producing organism

Answer 45

crepitus

Question 46

What are the most useful findings for pleural effusion?

Answer 46

tactile fremitus and dullness to percussion

Question 47

How can you evaluate tactile fremitus?

Answer 47

palmar surface, hand or finger tips, ulnar side of hands

Question 48

What is egophony?

Answer 48

say eeh and ayy

Question 49

When is bronchophony clearer?

Answer 49

airless or consildated lungs - lobar pneumonia/ pleural effusion

Question 50

What causes increased tactile fremitus?

Answer 50

lobar pneumonia of pleural effusion

Question 51

Where do you put your hands in thoracic expansion?

Answer 51

xiphoid process front | 10th rib in back

Question 52

What is normal percussion?

Answer 52

resonance

Question 53

What is hyperresonance related to?

Answer 53

emphysema, pneumothorax, asthma

Question 54

What is dullness of perscussion related to?

Answer 54

pneumonia, atelectasis, pleural effusion, pneumothoax, asthma

Question 55

What are some percussion errors?

Answer 55

Failing to exert firm pressure with the finger placed on the skin surface Failing to separate the hammer finger from other fingers Snapping downward from the elbow or shoulder rather than from the wrist Tapping by moving just the hammer finger rather than the whole hand Striking with the finger pad rather than the fingertip of the hammer finger Failing to trim the fingernail of the hammer finger

Question 56

What is the diaphragm for?

Answer 56

high pitched

Question 57

What is the bell for?

Answer 57

low pitched

Question 58

If you strongly suspect pathologic condition, what do you do with chest auscultation?

Answer 58

start at lung bases

Question 59

What causes crackles?

Answer 59

bronchitis, resp infection, pulm edema, atelectasis, fibrosis, CHF

Question 60

What causes wheezes?

Answer 60

asthma, pulm edema, bronchitis, CHF

Question 61

What causes rhonchus?

Answer 61

bronchitis

Question 62

What causes pleural rub?

Answer 62

pneumonia, pulmonary infarct

Question 63

What causes stridor?

Answer 63

after extubation, pertussis, croup, epiglottis, aspiration

Question 64

high pitched, discrete, discontinuous crackling or popping sounds heard during end of inspiration; not cleared by cough. Can sound like Velcro being pulled apart.

Answer 64

Fine crackles

Question 65

Lower, more moist sound heard during mid-stage of inspiration; not cleared by cough

Answer 65

Medium crackles

Question 66

loud, bubbly noise heard during inspiration; not cleared by cough.

Answer 66

coarse crakcles

Question 67

Loud, low, coarse sounds, like a snore, most often heard continuously during inspiration or expiration; coughing may clear the sound (usually means mucous accumulation in trachea or large bronchi).

Answer 67

rhonchi

Question 68

Musical noise sounding like a squeak; most often heard continuously during inspiration or expiration; usually louder during expiration

Answer 68

Wheeze

Question 69

Dry rubbing, creaking or grating sound, usually caused by inflammation of pleural surfaces; heard during inspiration or expiration; loudest over lower lateral anterior surface. Can sound like walking on fresh snow.

Answer 69

pleural friction rub

Question 70

a loud, high pitched sound heard during inspiration, but may occur throughout the entire respiratory cycle.

Answer 70

stridor

Question 71

What is something to note about back percussion?

Answer 71

dont do it over scapula, have pt lean forward

Question 72

What side is the diaphragm usually higher?

Answer 72

right

Question 73

What is normal diaphragmatic excusion?

Answer 73

3-5 cm

Question 74

When is diaphragm motion absent?

Answer 74

phrenic nerve palsy

Question 75

Where do you listen for middle lobe of right and lingula of left?

Answer 75

axillae