Lower Respiratory Exam

Question 1

anterior/posterior midaxillary line

Answer 1

the anterior and posterior axillary lines drops vertically from the anterior and posterior axillary folds. midaxillary line drops from the apex of the axilla

Question 2

midsternal line and midclavicular line

Answer 2

midsternal line drops from suprasternal notch. midclavicular line drops vertically from the midpoint of the clavicle

Question 3

needle decompression

Answer 3

2nd intercostal space just superior to the 3rd rib margin at the midclavicular line for emergent decompression tension pneumothorax followed by chest tube placement

Question 4

chest tube insertion

Answer 4

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

Question 5

T4

Answer 5

lower margin of endotracheal tube on a chest x ray

Question 6

7th intercostal space

Answer 6

landmark for thoracentesis

Question 7

tactile fremitus

Answer 7

perform on anterior and posterior chest
palpable vibrations transmitted through the bronchopulmonary tree the chest wall as the pt speaks 99 or 111 follow pattern to right
often more prominent in the interscapular area than in the lower lung fields and is more prominent on the R than the L
disappears below the diaphragm
decreases/absent fremitus - COPD, pleural effusions, fibrosis, pneumothorax, or an infiltrating tumor
increased fremitus - pneumonia (increased transmission through consolidated tissue)

Question 8

dullness replaces resonance

Answer 8

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

Question 9

generalized hyperresonance

Answer 9

hyper-inflated lungs
COPD
Asthma

Question 10

unilateral hyperresonance

Answer 10

large pneumothorax

large air filled bulla in lung

Question 11

diaphragmatic excursion

Answer 11

determines the distance b/w the level of dullness on full expiration and the level of dullness on full inspiration by progressive percussion down from resonance to dullness
normal - 3 to 5.5cm

Question 12

vesicular breath sounds

Answer 12

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

Question 13

bronchovesicular breath sounds

Answer 13

intermediate in intensity and pitch
heard equally in inspiration and expiration
heard best in 1st and 2nd interspaces anteriorly and b/w the scapulae

Question 14

tracheal breath sounds

Answer 14

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

Question 15

bronchovesicular or bronchial breath sounds are heard more distal to expected locations

Answer 15

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

Question 16

crackles (rales)

Answer 16

discontinuous intermittent nonmusical and brief
fine - soft high pitched brief
coarse - louder lower in pitch brief
timing in respiratory cycle

Question 17

wheezes and rhonchi

Answer 17

continuous musical quality and prolonged
wheezes - high pitched musical hissing or shrill quality, suggest narrowed airways
rhonchi - low pitched, snoring quality, secretions in large airways

Question 18

stridor

Answer 18

wheeze that is entirely or predominantly inspiratory in nature
often louder in neck vs chest wall
indicates partial obstruction of larynx or trachea

Question 19

pleural friction rub

Answer 19

inflamed and roughened pleural surfaces grate against each other as they are momentarily and repeatedly delayed by increased friction
sounds like creaking usually during expiration but can occur in both phases of respiration
usually confined to a relatively small area of the chest wall

Question 20

bronchophony

Answer 20

spoken words become louder and clearer when listening to lungs (99)

Question 21

egophony

Answer 21

the ee sounds like A

Question 22

whispered pectoriloquy

Answer 22

whispers are heard louder and clearer during auscultation