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PCM1 Final > Lower Respiratory Exam > Flashcards

Lower Respiratory Exam Flashcards

1
Q

Normal adult RR

A

14-20 breath/min

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2
Q

Pleximeter finger

A

Hyperextended middle finger of non-dominant hand in percussion of chest

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3
Q

Plexor finger

A

“Tapping” finger of dominant hand for percussion of chest

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4
Q

Anatomical location of the sternal angle

A

Where 2nd rib joins the sternum

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5
Q

Where is a needle thoracentesis performed?

A

2nd IC space, midclavicular line

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6
Q

Where is a chest tube inserted?

A

4th and 5th IC space, just anterior to the mid-axillary line

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7
Q

What to note in a lower respiratory PE

A 
Sitting position/breathing pattern
Use of accessory Ms.
Color of fingers/lips/nails
Breathing through pursed lips
Ability to speak
Chest and spinal deformities
Midline trachea
Chest excursion
Tactile fremitus
Percussion
Lung sounds
Lymphadenopathy
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8
Q

What does pulse oximetry measure?

A

Peripheral arterial oxygen saturation

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9
Q

What is end tidal CO2?

A

Concentration of CO2 in exhaled air at the end of respiration

Measures ventilation

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10
Q

Atelectasis

A

Loss of lung volume due to collapse of tissue

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11
Q

Pulmonary fxn test

A

Sit in a box and breath into a tube
Shows how well lungs work
Dx restrictive vs obstructive test

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12
Q

Spirometry

A

Measures amt and speed of air inhaled and exhaled

Also PFT

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13
Q

What marks the lower margin of the endotracheal tube on a CXR?

A

T4

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14
Q

What is the landmark for thoracentesis?

A

7th IC space

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15
Q

What is tripoding

A

Pts with obstructive lung disorders will sit leaning forward with shoulders elevated

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16
Q

What can tracheal deviation be seen in?

A

PNX
Pleural effusion
Atelectasis
Mass

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17
Q

Causes of nail clubbing

A 
Congenital heart dz
Interstitial lung dz
Bronchiectasis
Pulmonary fibrosis
Cystic fibrosis
Lung abscess
Malignancy
IBS
18
Q

Barrel chest

A

Increased AP diameter resembling a barrel

Seen in COPD

19
Q

Traumatic flail chest

A

Multiple rib fx may result in parodoxical movements of the thorax

20
Q

Tactile Fremitus

A

Palpable vibrations upon pt speaking

Decreased vibration can indicate COPD, pleural changes

Increased vibration can indicate PNA

Tested with 99 test

21
Q

What does generalized hyperresonance on chest percussion indicate

A

Hyperinflated lungs

COPD

22
Q

Unilateral hyperresonance through chest percussion indicates what?

A

Large PNX

Large air-filled bulla in lung

23
Q

How would a pt breath on lower respiratory auscultation?

A

Deeply with mouth open

24
Q

Normal breath sounds

A

Vesicular
Bronchovesicular
Bronchial
Tracheal

25
Q

Diaphragmatic excursion

A 
Pt exhales and completely holds
Percuss for level of diaphragm
Mark with pen
Pt breathes normally
Inhales completely and holds it
Percuss for level of diaphragm
Mark with pen
Distance b/w the two is diaphragmatic excursion

Normal is 3-5.5cm

26
Q

What does diaphragmatic excursion asymmetry indicate?

A

Pleural effusion

Atelectasis or phrenic nerve paralysis

27
Q

Adventitious breath sounds

A 
Stridor
Wheezes
Crackles
Rhonchi
Pleural friction rub
28
Q

Stridor

A

Narrowing in upper airway, generally inspiratory sound

Caused by croup, epiglottitis, upper airway FB, anaphylaxis

29
Q

Wheezing

A

Expiratory sound
Continuous musical sounds caused by rapid airflow through narrowed bronchial airway

RAD, asthma, COPD

30
Q

Crackles

A

Inspiratory, continuous musical sounds

Caused by small airway closed during expiration

PNA, CHF, atelectasis, pulmonary fibrosis, bronchiectasis, COPD, asthma

31
Q

Normal vocal resonance

A

Words are muffled and indistinct to auscultation
Whispered words are faint and indistict
Muffled long E on auscultation

32
Q

Bronchophony

A

Spoken words get louder

Indicates consolidation

33
Q

Whispered pectoriloquy

A

Whispered words are louder and clearer during auscultaiton

34
Q

Egophony

A

When pt says “ee” sounds like “A”

Fever and cough, may indicate PNA

35
Q

Vesicular sounds

A

Normal
Soft, low pitched
Heard through inspiration and 1/3 expiration
Heard over most of the lungs

36
Q

Bronchovesicular Sounds

A

Normal
Intermediate intensity and pitch
Heard equally in inspiration and expiration
Heard best in 1st and 2nd interspaces anteriorly and b/w scapulae

37
Q

Bronchial sounds

A

Normal
Loud, high pitched
Expiratory sounds heard longer than inspiratory
Heard best over manubrium

38
Q

Tracheal sounds

A

Normal
Loud, high pitched
Heard equally in inspiration and expiration
Heard best over trachea in neck

39
Q

Pleural friction rub

A

Inflamed and roughened pleural surface 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

40
Q

ABCs of CXR interpretation

A

Adequate/Assesment of quality

Airway

Bones and soft tissues

Cardiac size/valves

Diaphragms

Effusions/Endotracheal tube/EKG leads/wires

Fields and fissures/FB

Great vessels/Gastric bubble

Hilar masses

Impression

41
Q

What is a normal cardiac interpretation on PA films? AP?

A

<50% chest diameter on PA

<60% on AP film

PCM1 Final (13 decks)

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