clinical skills exam

Question 1

what sounds do you listen for with respiratory auscultation?

Answer 1

rales (crackles) hair rubbing together; pulmonary edema
rhonchi
wheezing
vesicular (normal breath sounds)
consolidation: excellent medium changing “aaa” to “eee” -egophony

Question 2

what does rhonchi sound like or suggest?

Answer 2

milk in a straw, gurlging, suggests bronchitis or mucus producing disorder

Question 3

what does rales/crackles sound like or suggest?

Answer 3

1. rubbing strands of hair together near ear; suggests pulmonary edema - fluid in alveolar and interstitial spaces
2. separating velcro - pulmonary fibrosis

Question 4

what does consolidation sound like and suggest?

Answer 4

consolidated lungs are excellent conducting mediums; transfers central sounds to edges. eg breathing in snorkel
- changes “eee” to “aaa” - egophony

Question 5

what suggests severe, stable emphysema?

Answer 5

produces very little sound in lungs

Question 6

will fremitus inc or dec over consolidaiton?

Answer 6

fremitus will inc over consolidation
fremiuts will dec over effusion

Question 7

what does dullness on percussion suggest?

Answer 7

lung consolidation or pleural effusion

Question 8

what are vessicular breath sounds?

Answer 8

normal tidal volumes

Question 9

what are wheezes?

Answer 9

air forced thro airways narrowed by bronchoconstriction, secretion or mucosal edema
m/c assoc with asthma or emphysema - processes that affect all lobes of lung

Question 10

what is stridor?

Answer 10

wheezing heard only on inspiration - mechanical obstruction at level of trachea/upper airway

Question 11

what does clubbing represent? How do you test it?

Answer 11

fingernails back to back to create widows peak
- result of long term low levels of oxygen (hypoexmia)
- common symptom of
respiratory disease, (lung cancer, cystic fibrosis,)
congenital heart disease (heart defect), gastro intestinal disorders (celiac)