Lower resp exam

Question 1

Regular Breathing Rate

Answer 1

14-20 x per minute

Question 2

Observation of Respiratory Difficulty

Answer 2

• patients color
• sounds of breathing
• neck inspection
• concerns pt expresses

Question 3

Inspection

Answer 3

• rate
• rhythm
• depth
• effort (lean forward-obstructive, speech-short sentences, pursed luips)
• clubbing of fingernails
• shape of chest and quality of movement

Question 4

Tactile Fremitus

Answer 4

• palpable vibrations transmitted though bronchopulmonary tree to the chest wall when pt speaks
• assess around medial and inferior border of scapula while pt repeats ‘99’

Question 5

Decreased Tactile Fremitus

Answer 5

• COPD
• pleural effusion
• pneumothorax
• infiltrating tumor

Question 6

Increased Tactile Fremitus

Answer 6

-pneumonia (increased transmission through consolidated tissue)

Question 7

2nd Intercostal Space

Answer 7

-needle insertion for tension pneumothorax

Question 8

4th Intercostal Space

Answer 8

-chest tube insertion

Question 9

T4

Answer 9

-lower margin of endotracheal tube on X-Ray

Question 10

7th Intercostal Space

Answer 10

-landmark for thoracentesis (fluid removal from between pleura and chest wall)

Question 11

Percussion

Answer 11

• assesses whether underlying tissues are air filled, fluid filled or solid via sound changes
• flat, dull, resonant, hyperresonant, tympanic

Question 12

Resonant

Answer 12

• healthy lungs

- replaced by dullness when fluid or solid tissues replaice air filled spaces

Question 13

Hyperresonance

Answer 13

• generalized (COPD)

- unilateral (large pneumothorax)

Question 14

Diaphragmatic Excursion

Answer 14

• boundary between resonant lung tissue and duller structures below the diaphragm
• not the diaphragm itself

-normally 3-5.5cm

Question 15

Auscultation

Answer 15

• assesses air flow through the tracheobronchial tree

- if abnormal sounds are heard, adjacent areas should be auscultated to asses the extent of the abnormality

Question 16

Normal Breath Sounds

Answer 16

• vesicular
• bronchiovesicular
• bronchial
• tracheal

Question 17

Resonance → Dullness

Answer 17

• when fluid or solid tissue replaces air filled spaces of the lungs
• ie. lobar pneumonia, pleural accumulations (effusion, hemothorax, empyema, fibrous tissue or tumor)

Question 18

Hyperresonance

Answer 18

• heartd over hyperinflated lungs
  ie. COPD, asthma

-unilateral suggests large pneumothorax, or air filled bulla

Question 19

Vesicular Breath Sounds

Answer 19

• soft; low pitched
• heard throughout inspiration
• heard through the first 1/3 of expiration then begins to fade
• heard over most of lung parenchyma

Question 20

Bronchovesicular Breath Sounds

Answer 20

• intermediate in intensity and pitch
• inspiratory and expiratory sounds approximately equal in length
• sounds originate at left/right bronchi bifurcations
• heard best in the 1st and 2nd anterior intercostal spaces
• heard best between scapulae posteriorly

Question 21

Bronchial Breath Sounds

Answer 21

• loud, harsh and high in pitch
• expiratory sounds are longer than inspiratory sounds
• separated by a short silence
• heard anteriorly at L/R bifurcations at level of sternal angle
• heard posteriorly at the T4 TP
• best heard over manubrium

Question 22

Tracheal Breath Sounds

Answer 22

• very loud and harsh
• inspiratory and expiratory sounds are approximately equal

-heard best over trachea in the neck

Question 23

Bronchovesicular or Bronchial Breath Sounds

Answer 23

-if heard distal to their normal locations, indicate normally air filled area has become fluid filled or a solid lung

Question 24

Diaphragm

Answer 24

-stethoscope portion used to auscultate lungs

Question 25

Depely Through Open mouth

Answer 25

-how patient should breathe for lung auscultation

Question 26

Ladder Pattern

Answer 26

-suggested for lung auscultation to allow L and R comparison

Question 27

Middle Lobe Auscultation

Answer 27

-anterior chest wall between 4th rib in midclavicular line

Question 28

Adventitious Breath Sounds

Answer 28

- extra breath sounds - may be superimposed over usual sounds -caused by crackles, wheezes, rhonchi and stridor

Question 29

Crackles (Rales)

Answer 29

- discontinuous - intermittent, non-musical, brief - can be inspiratory, expiratory or between - fine or coarse

Question 30

Fine Crackles

Answer 30

- soft, high pitched, very breif | - 5-10ms

Question 31

Course Crackles

Answer 31

- slightly louderm lower in pitch and brief | - 20-30ms

Question 32

Wheezes

Answer 32

- continuous - prolonged (not necessarily the entire respiratory cycle) - relatively high pitched, musical, hissing or shrill quality - suggests narrow airways (asthma, COPD, bronchitis)

Question 33

. Rhonchi

Answer 33

- continuous - prolonged (not necessarily the entire respiratory cycle) - low-pitched, snoring quality - suggests secretions in large airways

Question 34

Stridor

Answer 34

- wheeze that is entirely or predominantly inspiratory in nature - louder in neck vs. chest wall - indicates partial obstruction of larynx or trachea * requires immediate attention

Question 35

Transmitted Voice Sounds

Answer 35

- assessed if bronchovesicular or bronchial breath sounds are abnormal - ie. pneumonia, lobar consolidation, pleural effusion

Question 36

Bronchophony

Answer 36

-spoken words become louder and clearer

Question 37

Egophony

Answer 37

- 'ee' sounds like 'A' - nasal bleating quality and should be localized -when combined with fever and cough, bronchial breath sounds: 3x more likely pneumonia

Question 38

Whispered Pectoriloquy

Answer 38

-whispers are heard louder and clearer during auscultation

Question 39

Ninety-Nine

Answer 39

- when whispered, normally is muffled and indistinct | - bronchophony (also tactile fremitus)

Question 40

'99' or '1-2-3'

Answer 40

- whispered voice is normally faint and indistinct or not heard at all - whispered pectoriloquy

Question 41

Nail Clubbing

Answer 41

- bulbous swelling of soft tissue at nail base - loss of normal angle -indicates interstitial lung disease, cystic fibrosis, etc.

Question 42

Flat | -intensity, pitch, and duration

Answer 42

intensity:soft Pitch:high duration:short

Question 43

Dull | -intensity, pitch, and duration

Answer 43

intensity:medium Pitch:medium duration:medium

Question 44

Resonant | -intensity, pitch and duration

Answer 44

intensity: loud pitch: low Duration: Long

Question 45

hyperresonant | -intensity, pitch and duration

Answer 45

Intensity: very loud pitch: lower Duration: longer

Question 46

tympanic | -intensity, pitch and duration

Answer 46

intensity: loud pitch: high duration: longer