Lower Respiratory Exam Competency

Question 1

Where do you insert the Needle for Needle decompression? Chest Tube placement? Thoracentesis?

Answer 1

Needle Decompression: 2nd Intercostal space, SUPERIOR to the 3rd rib margin (Neurovascular bundle runs INFERIOR to each rib), @ the MIDCLAVICULAR line, followed by chest tube placement

Chest Tube: 4ith Intercostal Space, Mid or Anterior AXILLARY line (Just superior to the 5th rib)

Thoracentesis: 7th Intercostal Space

Question 2

Pursed lips while breathing can indicate what pathology?

Answer 2

Obstructive Lung Disease

Question 3

Tracheal deviation to one side or another can occur in what pathology?

Answer 3

Tension Pneumothorax

Question 4

Clubbing of the fingernails can be seen in which pathologies?

Answer 4

• Congenital Heart Disease
• Interstitial Lung Disease
• Lung Cancer
• Cystic Fibrosis

Question 5

Describe Tactile Fremitus.

Answer 5

• Performed on Anterior and Posterior chest
• Have Pt say “Ninety-nine” and you should feel for Palpable vibrations
• DECREASED/ABSENT: COPD, pleural effusions, fibrosis, pneumothorax, or an infiltrating tumor
• INCREASED: Pneumonia (increased transmission through the consolidated tissue)

Question 6

Differentiate between General and Unilateral Hyperresonance heard when percussing the lungs.

Answer 6

General: COPD and ASTHMA

Unilateral: Large pneuomothorax, Large air-filled bulla in lung

Question 7

What is a normal Diaphragmatic Excursion?

Answer 7

3-5.5 cm

Question 8

Describe the four normal breathe sounds and their relative locations.

Answer 8

1. VESICULAR: Soft and Low pitched, heard through INSPIRATION and 1/3 of EXPIRATION; Heard over most of the lungs (parenchyma)
2. BRONCHOVESICULAR: Intermediate in intensity and pitch, Head EQUALLY through inspiration and expiration; Heard best in 1st and 2nd IC spaces anteriorly and BETWEEN the SCAPULAE
3. BRONCHIAL: Loud and HIGH Pitched, EXPIRATORY sounds heard longer than Inspiratory; Heard best over the MANUBRIUM
4. TRACHEAL: VERY loud and HIGH pitched, Heard EQUALLY during inspiration and expiration; Heard best over TRACHEA and NECK

** If bronchovesicular or bronchial breath sounds are heard MORE DISTAL to expected locations, suspect AIR-FILLED lung has been replaced by FLUID-FILLED or SOLID lung tissue

Question 9

What type of pathology is associated with Wheezing?

Answer 9

Asthma, COPD, Bronchitis

Question 10

What type of pathology is associated with Rhonchi?

Answer 10

Suggests Secretions in LARGE AIRWAY (snoring-like noise)

Question 11

What type of pathology is associated with Stridor?

Answer 11

Obstruction in LARYNX or TRACHEA

** MEDICAL EMERGENCY

Question 12

Differentiate between Bronchophony, Egophony, and Whispered Pectoriloquy.

Answer 12

Bronchophony: Pt says “ninety-nine” and words become LOUDER and CLEARER

Egophony: Pt says “ee” and it sounds like “A”

Whispered Pectoriloquy: Whispers are heard LOUDER and CLEARER during auscultation

** All of these suggest PNEUMONIA, Consolidations in the lungs, or Effusions