Lab Refresher: Lower Respiratory Exam

Question 1

What is the location for emergent decompression of tension pneumothorax, followed by chest tube placement?

Answer 1

2nd ICS just superior to the 3rd rib margin at MCL

Question 2

What is the location for chest tube insertion?

Answer 2

4th ICS at mid or anterior axillary line in the 4th ICS just superior to the margin of 5th rib

Question 3

What is the landmark for thoracentesis?

Answer 3

7th ICS

Question 4

Where is tactile fremitus palpated more prominently?

Answer 4

• Interscapular area
• More prominent on the right

Question 5

List 6 conditions where there would be decreased/absent tactile fremitus?

Answer 5

• COPD
• Pleural effusions
• Fibrosis
• Pneumothorax
• Thick chest wall
• Infiltrating tumor

Question 6

In which conditions may there be generalized hyperresonance over the lungs?

Answer 6

• COPD/emphysema
• Asthma

*Conditions with hyperinflation

Question 7

What is normal diaphragmatic excursion?

Answer 7

3-5.5 cm

Question 8

When assessing diaphragmatic excursion, dullness at a level higher than expected suggests what?

Answer 8

Pleural effusions or a high diaphragm (as in atelectasis, or phrenic n. paralysis)

Question 9

When and where are vesicular breath sounds heard?

Answer 9

• Through inspiration and about 1/3 of expiration
• Heard over most of lungs (parenchyma)

Question 10

When and where are bronchovesicular sounds heard?

Answer 10

• Equally in inspiration and expiration
• Heard best in 1st and 2nd interspaces anteriorly and btw the scapulae

Question 11

When and where are bronchial sounds heard?

Answer 11

• Expiratory sounds heard longer than inspiratory
• Heard best over the manubrium

Question 12

Which breath sound is very loud and high pitched; and heard equally in inspiration and expiration?

Answer 12

Tracheal

Question 13

If bronchovesicular or bronchial breath sounds are heard more distal to expected locations, suspect what?

Answer 13

Air-filled lung has been REPLACED by fluid-filled or solid-lung tissue

Question 14

Which adventitious breath sound is characterized by being discontinous; intermittent, nonmusical and brief?

Answer 14

Crackles (rales)

Question 15

Which adventitious breath sound is characterized by a continous; musical quality and is prolonged?

Answer 15

Wheezes

Question 16

Which adventitious breath sound is characterized by being relatively low-pitched, snoring quality?

Answer 16

Rhonchi

Question 17

What do wheezes vs. rhonchi suggest?

Answer 17

• Wheezes = narrowed airways (asthma, COPD, bronchitis)
• Rhonchi = suggest secretions in large airways

Question 18

Which adventitious breath sound is characterized as a wheeze that is entirely or predominantly inspiratory in nature?

Answer 18

Stridor

Question 19

What is stridor indicative of?

Answer 19

Partial obstruction of larynx or trachea (medical emergency = immediate attention needed)

Question 20

What is Bronchophony; indicates what?

Answer 20

Spoken words become louder and clearer (indicates consolidation)

Question 21

What is Egophony?

Answer 21

• The “ee” sounds like “A.”
• The “A” has a nasal bleating quality and should be localized

Question 22

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

Answer 22

Pneumonia

Question 23

What is whispered pectoriloquy?

Answer 23

Whispers heard louder and clearer during auscultation

Question 24

Which breath sound should be predominantly heard over an air-filled lung?

Answer 24

Vesicular