Lower Respiratory Exam

Question 1

What is the Sternal angle?

Answer 1

It is where the 2nd rib meets with the manubriium and the body of the sternum

Question 2

What is the appropriate position for a needle decompression?

Answer 2

2nd intercostal space; just superior to the third rib margin

Question 3

What is the appropriate place for a chest tube insertion?

Answer 3

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

Question 4

What is the appropriate location for the lower end of a endotracheal tube?

Answer 4

T4

Question 5

What is the appropriate landmark for a thoracentesis?

Answer 5

7th ICS

Question 6

What is seen in patients with obstructive lung disease; general physical exam?

Answer 6

Pursed lip breathing; tripod position

Question 7

What is seen in pts w/ a tensoin pneumothorax?

Answer 7

Unilateral deviation of trachea

Question 8

What does clubbing of the fingernails indicate?

Answer 8

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

Question 9

What is Tactile Fremitus; and where is it heard?

Answer 9

Tactile Fremitus: Palpalbale vibrations, while patients speaks “99” or “one=one=one”

Heard more along the intrascapular region and along the right side

Increased: Px

decreased: COPD, PEffusions, or infiltrating tumor

Question 10

What is the diaphragmatic excursion and how is it measured?

Answer 10

Measure of distance from lung parenchyma to the structures below the diaphragm.

measured by; Full expiration (find resonance into dullness) -> inspiration (find dullness)

Normal: 3.0-5.5 cm
Decreases size; COPD

Question 11

What are some characteristics of vesicular breath sounds?

Answer 11

1) Soft and low pitched
- Heard through inspiration and 1/3rd of expiration
- Hear over most of the lungs

Question 12

What are bronchovesicular lung sounds?

Answer 12

Intermediate in intensity and pitch

• Heard equally with inspiration and expiration
• Heard best between 1st and 2nd interspaces anteriorly and between the scapulae

Question 13

What are bronchial lung sounds and when are they best heard?

Answer 13

Loud and high pitched

• expiratory heard longer than inspiratory
• Heard best over the manumbrium

Question 14

What are tracheal lung sounds and when are they best heard?

Answer 14

Very loud and high pitched

• Heard equally in inspiration and expiration
• Heard best over the trachea and neck

Question 15

What is to be expected if brochovesicular or bronchial breath sounds are head more distal to expected locations?

Answer 15

Air filled lung has been replaced by solid filled tissue

Question 16

What are Wheezes and what pathologies do they suggest when heard/

Answer 16

Continuous and musical quality; high pitched

- SUggest: narrowed airways (COPD< Asthma)

Question 17

What are Rhonchi and what pathologies do they sugggest?

Answer 17

• Low pitched, snoring quality

- Sugggest: Secretions in the airway

Question 18

What is stridor and what pathologies does it suggest when heard?

Answer 18

• Wheeze that is predominantly inspiratory in nature

- Partial obstruction of the largynx and trachea (Immediate atttention needed)

Question 19

What does a pleural friction rub sound like?

Answer 19

Creaking, during expiration, confined to a small area of the chest

Question 20

What is bronchophony?

Answer 20

Path: Spoken words become clearer; normally it is mufffled

Question 21

What is Egophany?

Answer 21

E sounds like A; (normally muffled long E sound)

Question 22

What is more likely in a patient with fever, cough, bronchial breath sounds, and egophony?

Answer 22

Px

Question 23

What is whispered pectoriloquy?

Answer 23

Whispers are heard louder and clearer during auscultation

Question 24

Bradypnea; is defined as what?

Answer 24

RR < 12 min

Question 25

Hyperpnea; is defined as?

Answer 25

RR > 25 min

Question 26

How is % saturation calculated on a Pulse Ox device?

Answer 26

Oxyhemoglobin / (oxyhemoglobin + deoxyhhemoglobin)