Lower respiratory exam

Question 1

Where does needle decompression normally happen?

Answer 1

the 2nd intercostal space just superior to the 3rd rib margin, at the mid clavicular line
-(the neurovascular bundle runs inferior to each rib

Question 2

Why do we do needle decompression?

Answer 2

to decompress tension pneumothorax, usually followed by a chest tube placement

Question 3

Where do we insert a chest tube?

Answer 3

4th intercostal space just superior to the 5th rib at mid or anterior axillary line in t

Question 4

where does the lower margin of the endotracheal tube show up on a chest x-ray?

Answer 4

T4

Question 5

Where is the landmark for thoracentesis?

Answer 5

7th intercostal space

Question 6

what is the normal respiratory rate for an adult?

Answer 6

14-20/minute

Question 7

If a patient is breathing through pursed lips, what does that mean?

Answer 7

obstructive lung disease

Question 8

how do patients w/ obstructive lung disorders tend to sit?

Answer 8

leaning forward with shoulders elevated

Question 9

What do we look for in the fingernails?

Answer 9

clubbing

Question 10

What is tactile fremitus?

Answer 10

having the patient say “99” and palpating for vibrations on their chest… usually between their scapulae… more prominent on the right

Question 11

What does decrease/absent fremitus mean?

Answer 11

COPD, pleural effusions, fibrosis, pneumothoraax, or an infiltrating tumor

Question 12

What does increased fremitus mean?

Answer 12

Pneumonia- increased transmission through consolidated tissue

Question 13

Why do we percuss the chest?

Answer 13

to find our whether the underlying tissues are filled with air, fluid, or just solid

Question 14

What are the 5 different kinds of percussion notes?

Answer 14

Flat
Dull
Resonant
Hyperresonant
Tympanitic

Question 15

Flat

Answer 15

Soft, high-pitched, and short

Question 16

Dull

Answer 16

medium everything

Question 17

Resonant

Answer 17

loud, low pitched, long

Question 18

hyperresonant

Answer 18

very loud, lower pitched, longer

Question 19

tympanitic

Answer 19

loud, high pitched, longer

Question 20

When does dullness replace resonance?

Answer 20

when fluid or solid tissue replaces air-containing lung or occupies space beneath percussing fingers

Question 21

When can hyperresonance be heard?

Answer 21

with hyperinflated lungs (COPD or asthma)

Question 22

what does unilateral hyperresonance sugger?

Answer 22

large pneumothorax or large air-filled bulla in lung

Question 23

What is the normal diaphragmatic excursion?

Answer 23

3-5.5 cm. that’s when you percuss when the pt. inhales and exhales to see how the diaphragm moves

Question 24

Where should we auscultate on the chest?

Answer 24

at least the lobes of each lung

Question 25

What kind of sounds are made in the lungs?

Answer 25

Vesicular
Bronchovesicular
Bronchial
tracheal

Question 26

Describe vesicular breath sounds

Answer 26

Soft and low pithced
heard through inspiration and about 1/3 of expiration
heard over most of lungs (parenchyma)

Question 27

describe bronchovesicular sounds

Answer 27

intermediate in intensity and pitch
heard equally in inspiration and expiration
heard best in 1st and 2nd intercostal spaces anteriorly and between the scapulae

Question 28

describe bronchial sounds

Answer 28

loud and high pitched
expiratory sounds heard longer than inspiratory
heard best ove manubrium (larger proximal airways)

Question 29

describe tracheal sounds

Answer 29

very loud and high pitched
heard equally in inspiration and expiration
head best over trachea in neck

Question 30

what should we suspect in we hear bronchovesicular or bronchial breath sounds more distal to expected locations?

Answer 30

air-filled lung has been replaced by fluid-filled or solid lung tissue

Question 31

What is the difference between a wheeze and a rhonchus?

Answer 31

Wheezes are higher pitched and they mean asthma, COPD, or bronchitis
Ronchi are low-pitched, snoring quality and they suggest secretions in large airways

Question 32

What is a stridor?

Answer 32

a wheeze that is entirely or inspiratory in nature

• often louder in neck vs. chest wall
• indicates partial obstruction of larynx or trachea (immediate attention needed!)

Question 33

Pleural friction rub

Answer 33

pleural surfaces rubbing against one another

• makes a creaking sound during expiration
• usually confined to a relatively small area of the chest wall

Question 34

What is bronchophony?

Answer 34

when a patients words are louder and clearer than normal while auscultating the lungs

Question 35

What is egophony?

Answer 35

patient says “ee” and it sounds like “A”
*in pts. with fever and couch, the presence of bronchial breath sounds and egophony more than triples the likelihood of pneumonia

Question 36

What is whicpered pectoriloquy?

Answer 36

when a patient whispers “99” and the whispers are heard louder and clearer during auscultation
-present in an airless lung like pneumonia

Question 37

What are the characteristics of a normal Air-filled Lung?

Answer 37

sounds predominantly vesicular

-spoken and whispered words are muffled and indistinct… “ee” is normal

Question 38

What is an airless lung like lobar pneumonia like?

Answer 38

sounds bronchial or bronchovesicular over the involved area

• bronchophony, egophony, and whispered pectoriloquy are present
• Tactile fremitus is increased