Lower Respiratory Exam OSCE Flashcards
landmarks to identify when inspecting the chest during a respiratory exam
sternal angle of louis (where 2nd rib meets the manubrium and body of sternum) suprasternal notch xiphoid process Scapula Thoracic vertebrae
Insertion site of needle decompression
2nd intercostal space, just superior to 3rd rib margin at midclavicular line
the neurovascular bundle runs _____ to each rib
inferior
insertion site for chest tubes
4th intercostal space at mid/anterior axillary line, just superior to the margin of the 5th rib
thoracentesis insertion site
7th intercostal space
the lower margin of endotracheal tube can be seen at T___ on a chest xray
T4
quiet, regular breathing has a rate of __ to __ x a min
14-20
pursed lips while breathing may indicate
COPD
lateral tracheal displacement can occur during what emergent medical crisis
tension pneumothorax
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
clubbing
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
10th ribs
palpable vibrations transmitted through the bronchopulmonary tree to the chest wall as the patient speaks occurs during what test
tactile fremitus
under normal conditions, fremitus is more prominent in what areas
interscapular area in the lower lung fields
more prominent on right than left
fremitus is decreased/absent in what pathologies
COPD, pleural effusions, fibrosis, pneumothorax, infiltrating tumor
fremitus is increased in what pathology
pneumonia
increased transmission of sound through fluid/consolidated tissue
by percussing the chest, you can tell if the underlying tissues are
___ -filled, ____ filled, or _____
air filled
fluid filled
solid
before percussing a patients chest, what position should they be in
seated with both arms crossed in front of chest
dullness replaces resonance during percussion when fluid or solid tissue replaces
air containing lungs/ occupies space beneath percussing fingers
Pneumonia
Pleural accumulations (effusions, hemothorax, empyema, fibrous tissue/ tumor)
hyperresonance can be heard hyperinflated lungs, such as in patients with
COPD/Emphysema
Asthma
Unilateral hyperresonance suggest s
large pneumothorax
large air-filled bulla in lung
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)
3-5.5 cm
describe vesicular breath sounds
soft/low pitched
heard through inspiration and 1/3 expriation
heard over most of lungs (parenchyma)
describe bronchovesicular breath sounds
intermediate in intensity and pitch, heard equally in inspiration/expiration
heard best in 1st/2dn interspaces anteriorly or between scapula
bronchial sounds can be best heard over
manubrium (larger proximal airways)
bronchial sounds are those of the
major airways
bronchial sounds are loud and
high pitched, longer in expiratory
tracheal sounds are very loud and
high pitched
tracheal sounds are best heard
over trachea in neck
if bronchovesicular or bronchial breath sounds are heard mroe distal to expected locations, suspect air-filled lung as been replaced by
fluid-filled /solid lung tissue
discontinuous, intermittent, nonmusical and breath adventitious breath sounds
crackles (rales)
crackles can be ____ or _____
Fine - soft, high pitched, very brief
Coarse - louder, lower, brief
continuous; musical quality and prolonged adventitious breath sounds
wheezes
wheezes suggest what has happened to the airway
narrowing of the airway
relatively low pitched, snoring quality
rhonchi
rhonchi suggest what has happened to an airway
secretions in large airway
wheeze that is entirely or predominantly inspiratory and indicates a partial obstruction of larynx or trachea
stridor
when inflamed or roughened pleural surfaces grate against each other as they are momentarily and repeatedly delayed by increased friction occursi n
pleural friction rub
creaking, usually during expiration but can occur in both phases of respiration (adventitious breath sounds)
pleural friction rub sounds
phenomenon that occurs if, while patient is saying ninety nine, the spoken words become louder and clearer during auscultation instead of muffled and indistinct
bronchophony
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
pneumonia
normally, a whispered voice during auscultation is not heard or is faint and indistinct, unless the patient has
whispered petoriloquy
