Exam 3 - Chest Exam

Question 1

ribs 1-7 articulate with _______.

Answer 1

sternum

Question 2

ribs 8, 9, 10 articulate with ________________.

Answer 2

costal cartilages

Question 3

11th rib is

Answer 3

floating, feel tip laterally

Question 4

12th rib is

Answer 4

floating, feel tip posteriorly

Question 5

2nd rib articulates with

Answer 5

sternal angle

Question 6

Inferior angle of scapula is at level of the ___ rib posteriorly.

Answer 6

7th

Question 7

you can only access middle lobe sounds __________.

Answer 7

anteriorly

Question 8

apex of lung is ______ above clavicle

Answer 8

2-4 cms

Question 9

Lower border of lung at 6th rib at ___________________.

Answer 9

mid clavicular line

Question 10

lower border of lung at 8th rib at ________________.

Answer 10

midaxillary line

Question 11

Lower border for lung at 10th thoracic spinous process

Answer 11

posteriorly

Question 12

The sternal angle bifurcates into the main stem bronchi at _____________ anteriorly and at __ posteriorly .

Answer 12

sternal angle, T4

Question 13

_________ space is between the visceral pleura (on the organ) and parietal pleura

Answer 13

potential

Question 14

inspection of chest

Answer 14

masses/lesions
position of trachea
shape/symmetry
chest deformities
AP/lateral diameter
inspiratory retractions
local lag
Rate (14-20)
Rhythm, death, effort
use of accessory muscles

Question 15

Palpation

Answer 15

ID areas of tenderness or suspicious
ID masses
Respiratory expansion - this can confirm local lag

Question 16

Tactile Fremitus

Answer 16

palpable vibrations with speech

decreased over the heart, scapulae

scouting technique , compare B/l

Question 17

Indications in which TF will be dampened

Answer 17

soft voice
thick chest wall
obese
COPD
plural effusion
fibrosis
penumothorax

Question 18

percussion

Answer 18

helps detect air-filled vs. fluid filled or solid

Question 19

vesicular

Answer 19

soft, low pitched

inspir > expir = normal

Question 20

Bronchial

Answer 20

louder, high pitched (sternal notch)

expir > inspir = normal

Question 21

Bronchovesicular

Answer 21

intermediate sound and pitch

inspir = expir

Question 22

tracheal

Answer 22

very loud, high pitch

inspir = expir

Question 23

adventitious sounds

Answer 23

crackles
wheezes
rhonchi
stridor
pleural friction rub

Question 24

crackles (rales)

Answer 24

intermittent, non musical, brief - fine or coarse

small airways popping open with inspiration
air bubbles moving through secretions

Question 25

crackles are normally heard at ______________.

Answer 25

anterior bases, after prolonged bed rest, w/ HF heard throughout the respiratory cycle

Question 26

wheezes

Answer 26

longer than crackles, musical, may clear with a cough ( so check again) high pitch, hiss or shrill quality suggests a narrowed pathway NOT heard throughout the respiratory cycle

Question 27

Rhonchi

Answer 27

low pitch, snoring quality longer than a crackle suggests larger airways may clear with cough NOT heard throughout the respiratory cycle

Question 28

Stridor

Answer 28

inspiratory wheeze, especially in neck indicates partial obstruction of larynx or trachea immediate TX required

Question 29

Pleural Friction Rub

Answer 29

inflamed, roughened pleural surfaces grating against each other, creaking leathery sound Usually confined to a small area If effusion develops into the potential space, then the rub may disappear

Question 30

Bronchophony (spoken word)

Answer 30

if fluid in lung then word is louder and clearer

Question 31

Egophony

Answer 31

eeeeeeeww, fluid will make it sound more like ayyyyyyyyy

Question 32

Whispered pectoriloquy (whispered word)

Answer 32

fluid will enhance it, normally it is really hard to hear

Question 33

tachypnea

Answer 33

rapid / shallow breathing - acidosis, restrictive lung disease, pain, pregnant

Question 34

Hyperpnea

Answer 34

rapid and deep, exercise, anxiety and hypoxic people

Question 35

Bradypnea

Answer 35

slow breathing, diabetic coma, drug induced increased ICP

Question 36

Kussmaul

Answer 36

deep breathing but a fast normal or slow rate METABOLIC ACIDOSIS

Question 37

Cheyne- Stokes

Answer 37

alternating periods of hyperpnea and apnea can be normal in children and older adults when sleeping CHF, drugs or brain damage

Question 38

Ataxic Breathing (Biot's)

Answer 38

unpredictable, irregular shallow, deep, apnea brain damage

Question 39

Obstructive Breathing

Answer 39

prolonged expiration, increased resistance in narrowed airway, asthma,, FB,

Question 40

Pectus excavatum - funnel chest

Answer 40

depressed sternum compressed heart and great vessels reconstructive surgery if severe

Question 41

Pectus carinatum - pigeon chest

Answer 41

sternum is anterior , increased AP diameter depresses costal cartilages laterally

Question 42

Thoracic Kyphoscoliosis

Answer 42

hunch back with vertebral rotation

Question 43

Forced Vital Capacity (FVC)

Answer 43

measure the amount of air you can force out after you inhale as deep as you can.

Question 44

Forced expiratory Volume (FEV)

Answer 44

measures the amount of air one can exhale with force in one breathe. 1 sec. FEV1 2 sec FEV2 3 sec FEV3 FEV1/FVC

Question 45

Forced Expiratory flow 25%-75%

Answer 45

this measures the air flow halfway through an exhale

Question 46

Peak Expiratory Flow (PEF)

Answer 46

measures how much air you can exhale when you try your hardest. measured at the same time as FVC

Question 47

Maximum voluntary ventilation (MVV)

Answer 47

measures the greatest amount of air you can breathe in and out during 1 minute

Question 48

Slow vital capacity (SVC)

Answer 48

measures how much air you can breathe out slowly after you inhale as deep as you can

Question 49

Total Lung Capacity (TLC)

Answer 49

measures the amount of air in your lungs after you inhale as deep as possible

Question 50

Functional Residual Capacity (FRC)

Answer 50

measures the amount of air in your lungs at the end of a normal exhaled breath

Question 51

Residual Volume (RV)

Answer 51

measures the amount of air in your lungs after you have exhaled completely. It can be done by breathing in helium or nitrogen gas and seeing how much is exhaled

Question 52

Expiratory reserve volume (ERV)

Answer 52

measures the difference between the amount of air in your lungs after a normal exhale (FRC) and the amount after you exhale with force (RV)

Question 53

medication for loss of consciousness

Answer 53

etomidate, ketamine, propofol, versed

Question 54

paralyzing agent

Answer 54

succinylchloride

Question 55

what is better for patient who have not faster

Answer 55

RSI