Lower Respiratory Exam OSCE

Question 1

landmarks to identify when inspecting the chest during a respiratory exam

Answer 1

sternal angle of louis (where 2nd rib meets the manubrium and body of sternum) 
suprasternal notch
xiphoid process
Scapula
Thoracic vertebrae

Question 2

Insertion site of needle decompression

Answer 2

2nd intercostal space, just superior to 3rd rib margin at midclavicular line

Question 3

the neurovascular bundle runs _____ to each rib

Answer 3

inferior

Question 4

insertion site for chest tubes

Answer 4

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

Question 5

thoracentesis insertion site

Answer 5

7th intercostal space

Question 6

the lower margin of endotracheal tube can be seen at T___ on a chest xray

Answer 6

T4

Question 7

quiet, regular breathing has a rate of __ to __ x a min

Answer 7

14-20

Question 8

pursed lips while breathing may indicate

Answer 8

COPD

Question 9

lateral tracheal displacement can occur during what emergent medical crisis

Answer 9

tension pneumothorax

Question 10

loss of normal angle between nail and proximal nail fold, as seen in congenital heart disease, interstitial lung disease, bronchiectasis, pulmonary fibrosis, lung abcess, IBD, cystic fibrosis, and lung cancer is called

Answer 10

clubbing

Question 11

in order to check thoracic expansion, thumbs are placed at the __ ribs, fingers loosely grasping and parallel to the rib cage while patient inhales deeply, watching the thumbs as they move apart during inspiration

Answer 11

10th ribs

Question 12

palpable vibrations transmitted through the bronchopulmonary tree to the chest wall as the patient speaks occurs during what test

Answer 12

tactile fremitus

Question 13

under normal conditions, fremitus is more prominent in what areas

Answer 13

interscapular area in the lower lung fields

more prominent on right than left

Question 14

fremitus is decreased/absent in what pathologies

Answer 14

COPD, pleural effusions, fibrosis, pneumothorax, infiltrating tumor

Question 15

fremitus is increased in what pathology

Answer 15

pneumonia

increased transmission of sound through fluid/consolidated tissue

Question 16

by percussing the chest, you can tell if the underlying tissues are
___ -filled, ____ filled, or _____

Answer 16

air filled
fluid filled
solid

Question 17

before percussing a patients chest, what position should they be in

Answer 17

seated with both arms crossed in front of chest

Question 18

dullness replaces resonance during percussion when fluid or solid tissue replaces

Answer 18

air containing lungs/ occupies space beneath percussing fingers
Pneumonia
Pleural accumulations (effusions, hemothorax, empyema, fibrous tissue/ tumor)

Question 19

hyperresonance can be heard hyperinflated lungs, such as in patients with

Answer 19

COPD/Emphysema

Asthma

Question 20

Unilateral hyperresonance suggest s

Answer 20

large pneumothorax

large air-filled bulla in lung

Question 21

normal diaphragmatic excursion (distance between the level of dullness on full expiration and the level of dullness on full inspiration by progressive percussion down from resonance (lung parenchyma) to dullness (structures below diaphragm)

Answer 21

3-5.5 cm

Question 22

describe vesicular breath sounds

Answer 22

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

Question 23

describe bronchovesicular breath sounds

Answer 23

intermediate in intensity and pitch, heard equally in inspiration/expiration
heard best in 1st/2dn interspaces anteriorly or between scapula

Question 24

bronchial sounds can be best heard over

Answer 24

manubrium (larger proximal airways)

Question 25

bronchial sounds are those of the

Answer 25

major airways

Question 26

bronchial sounds are loud and

Answer 26

high pitched, longer in expiratory

Question 27

tracheal sounds are very loud and

Answer 27

high pitched

Question 28

tracheal sounds are best heard

Answer 28

over trachea in neck

Question 29

if bronchovesicular or bronchial breath sounds are heard mroe distal to expected locations, suspect air-filled lung as been replaced by

Answer 29

fluid-filled /solid lung tissue

Question 30

discontinuous, intermittent, nonmusical and breath adventitious breath sounds

Answer 30

crackles (rales)

Question 31

crackles can be ____ or _____

Answer 31

Fine - soft, high pitched, very brief

Coarse - louder, lower, brief

Question 32

continuous; musical quality and prolonged adventitious breath sounds

Answer 32

wheezes

Question 33

wheezes suggest what has happened to the airway

Answer 33

narrowing of the airway

Question 34

relatively low pitched, snoring quality

Answer 34

rhonchi

Question 35

rhonchi suggest what has happened to an airway

Answer 35

secretions in large airway

Question 36

wheeze that is entirely or predominantly inspiratory and indicates a partial obstruction of larynx or trachea

Answer 36

stridor

Question 37

when inflamed or roughened pleural surfaces grate against each other as they are momentarily and repeatedly delayed by increased friction occursi n

Answer 37

pleural friction rub

Question 38

creaking, usually during expiration but can occur in both phases of respiration (adventitious breath sounds)

Answer 38

pleural friction rub sounds

Question 39

phenomenon that occurs if, while patient is saying ninety nine, the spoken words become louder and clearer during auscultation instead of muffled and indistinct

Answer 39

bronchophony

Question 40

in patients with fever and cough, bronchnial breath sounds, and positive egophony test (ee sound is heard as A in auscultation) what should be suspected

Answer 40

pneumonia

Question 41

normally, a whispered voice during auscultation is not heard or is faint and indistinct, unless the patient has

Answer 41

whispered petoriloquy