Lower Respiratory Exam

Question 1

Where does needle decompression occur?

Answer 1

2nd ICS, superior to 3rd rib margin, at mid-clavicular line

Question 2

Where does chest tube insertion occur?

Answer 2

4th ICS, @ mid/anterior axillary line, superior to margin of 5th rib

Question 3

Where is the lower margin of endotracheal tube on a chest X-ray?

Answer 3

T4

Question 4

What is the landmark for thoracentesis?

Answer 4

7th ICS

Question 5

If a pt. is breathing with pursed lips or is sitting leaning forward with their shoulder elevated, what is a common cx?

Answer 5

Obstructive lung disease

Question 6

What does lateral displacement of the trachea commonly associate with?

Answer 6

Pneumothorax

Question 7

What is fingernail clubbing commonly seen in?

Answer 7

Congenital heart disease, interstitial lung disease, lung cancer, cystic fibrosis

Question 8

What is thoracic expansion?

Answer 8

Place thumbs at 10th ribs with hands parallel to lateral rib cage.
Watch distance between thumbs as pt. inhales deeply

Question 9

What is tactile fremitus?

Answer 9

Palpable vibrations transmitted through broncho-pulmonary tree to chest wall as pt. speaks

Question 10

Where is tactile fremitus most prominent?

Answer 10

Interscapular area and right side

Question 11

Decreased fremitus is commonly associated with what?

Answer 11

COPD, pleural effusion, fibrosis, pneumothorax

Question 12

Increased fremitus is commonly associated with what?

Answer 12

Penumonia

Question 13

What joint do yo strike during percussion?

Answer 13

DIP

Question 14

What are examples of areas that would have the flat, dull, resonant, hyper-resonant, and tympanic sounds?

Answer 14

Flat - thigh
Dull - liver
Resonant - healthy lung
Hyper-resonant - hyper-inflated lungs
Tympanic - Gastric air bubble

Question 15

What is diaphragmatic excursion? Where would resonance and dullness be? What is normal?

Answer 15

Distance between dullness during full expiration and inspiration
Resonance = Parenchyma
Dullness = structures below diaphragm
Normal = 3-5.5 cm

Question 16

Explain vesicular breath sound.

Answer 16

Soft/low pitch
Through inspiration and 1/3 of expiration
Over most of lung

Question 17

Explain broncho-vesicular breath sound.

Answer 17

Intermediate intensity/pitch
Equally in inspiration/expiration
Best in 1st/2nd ICS and between scapulae

Question 18

Explain bronchial breath sound.

Answer 18

Loud/high pitch
Longer during expiration than inspiration
Over manubrium

Question 19

Explain tracheal breath sound.

Answer 19

Very loud/high pitch
Equally in inspiration/expiration
Over trachea

Question 20

Explain rales.

Answer 20

Intermittent, brief
Fine crackles = soft, high pitch 5-10 msec
Coarse crackles = louder, lower pitch, 20-30 msec

Question 21

Explain wheezes.

Answer 21

High pitch hissing/shrill

Suggest narrow airways; COPD, asthma, bronchitis

Question 22

Explain rhonchi.

Answer 22

Low pitch, snoring

Suggest secretions in large airways

Question 23

Explain stridor.

Answer 23

Wheeze entirely during inspiration
Louder in neck vs chest
Suggests partial obstruction of larynx/trachea
*immediate attention

Question 24

Explain pleural friction rub.

Answer 24

Inflamed, roughened pleural surfaces rubbing together
Sounds like creaking
Usually during expiration
Confined to small area of chest

Question 25

Explain the "ninety-nine" transmitted voice sound test and what dx is associated with it.

Answer 25

``` Normal = muffled sound Pathology = spoken words become louder/clearer Dx = Bronchophony ```

Question 26

Explain the "ee" transmitted voice sound test and what dx is associated with it.

Answer 26

``` Normal = muffled "E" sound Pathology = "ee" sounds like "A" Dx = Egophoney ```

Question 27

Explain the whisper "ninety-nine" or "one-two-three" transmitted voice sound test and what dx is associated with it.

Answer 27

``` Normal = sound is indistinct, faint Pathology = whispers are louder and clearer Dx = Whispered Pectoriloquy ```