Lower Respiratory Exam

Question 1

Normal adult RR

Answer 1

14-20 breath/min

Question 2

Pleximeter finger

Answer 2

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

Question 3

Plexor finger

Answer 3

“Tapping” finger of dominant hand for percussion of chest

Question 4

Anatomical location of the sternal angle

Answer 4

Where 2nd rib joins the sternum

Question 5

Where is a needle thoracentesis performed?

Answer 5

2nd IC space, midclavicular line

Question 6

Where is a chest tube inserted?

Answer 6

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

Question 7

What to note in a lower respiratory PE

Answer 7

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

Question 8

What does pulse oximetry measure?

Answer 8

Peripheral arterial oxygen saturation

Question 9

What is end tidal CO2?

Answer 9

Concentration of CO2 in exhaled air at the end of respiration

Measures ventilation

Question 10

Atelectasis

Answer 10

Loss of lung volume due to collapse of tissue

Question 11

Pulmonary fxn test

Answer 11

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

Question 12

Spirometry

Answer 12

Measures amt and speed of air inhaled and exhaled

Also PFT

Question 13

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

Answer 13

T4

Question 14

What is the landmark for thoracentesis?

Answer 14

7th IC space

Question 15

What is tripoding

Answer 15

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

Question 16

What can tracheal deviation be seen in?

Answer 16

PNX
Pleural effusion
Atelectasis
Mass

Question 17

Causes of nail clubbing

Answer 17

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

Question 18

Barrel chest

Answer 18

Increased AP diameter resembling a barrel

Seen in COPD

Question 19

Traumatic flail chest

Answer 19

Multiple rib fx may result in parodoxical movements of the thorax

Question 20

Tactile Fremitus

Answer 20

Palpable vibrations upon pt speaking

Decreased vibration can indicate COPD, pleural changes

Increased vibration can indicate PNA

Tested with 99 test

Question 21

What does generalized hyperresonance on chest percussion indicate

Answer 21

Hyperinflated lungs

COPD

Question 22

Unilateral hyperresonance through chest percussion indicates what?

Answer 22

Large PNX

Large air-filled bulla in lung

Question 23

How would a pt breath on lower respiratory auscultation?

Answer 23

Deeply with mouth open

Question 24

Normal breath sounds

Answer 24

Vesicular
Bronchovesicular
Bronchial
Tracheal

Question 25

Diaphragmatic excursion

Answer 25

``` 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

Question 26

What does diaphragmatic excursion asymmetry indicate?

Answer 26

Pleural effusion | Atelectasis or phrenic nerve paralysis

Question 27

Adventitious breath sounds

Answer 27

``` Stridor Wheezes Crackles Rhonchi Pleural friction rub ```

Question 28

Stridor

Answer 28

Narrowing in upper airway, generally inspiratory sound Caused by croup, epiglottitis, upper airway FB, anaphylaxis

Question 29

Wheezing

Answer 29

Expiratory sound Continuous musical sounds caused by rapid airflow through narrowed bronchial airway RAD, asthma, COPD

Question 30

Crackles

Answer 30

Inspiratory, continuous musical sounds Caused by small airway closed during expiration PNA, CHF, atelectasis, pulmonary fibrosis, bronchiectasis, COPD, asthma

Question 31

Normal vocal resonance

Answer 31

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

Question 32

Bronchophony

Answer 32

Spoken words get louder Indicates consolidation

Question 33

Whispered pectoriloquy

Answer 33

Whispered words are louder and clearer during auscultaiton

Question 34

Egophony

Answer 34

When pt says "ee" sounds like "A" Fever and cough, may indicate PNA

Question 35

Vesicular sounds

Answer 35

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

Question 36

Bronchovesicular Sounds

Answer 36

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

Question 37

Bronchial sounds

Answer 37

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

Question 38

Tracheal sounds

Answer 38

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

Question 39

Pleural friction rub

Answer 39

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

Question 40

ABCs of CXR interpretation

Answer 40

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

Question 41

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

Answer 41

<50% chest diameter on PA <60% on AP film