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PCM I Final > Lower Respiratory OSCE > Flashcards

Lower Respiratory OSCE Flashcards

1
Q

Anatomical landmarks during inspection of the chest

A

Sternal angle - where second rib meets with manubrium and sternal body

Suprasternal notch

Xiphoid process

Scapula

Thoracic vertebrae

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2
Q

Landmarks for needle decompression

A

2nd intercostal space just superior to the 3rd rib margin at the midclavicular line for emergent decompression tension pneumothorax, followed by chest tube placement

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3
Q

Landmarks for chest tube insertion

A

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

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4
Q

T___ = lower margin of endotracheal tube on CXR

A

4

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5
Q

Landmark for thoracentesis

A

7th intercostal space

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6
Q

Normal respiratory rate

A

14-20x/min

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7
Q

Pursed lips while breathing is indicative of what condition

A

COPD

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8
Q

Why would you inspect the neck during respiratory exam?

A

Contraction of accessory muscles (SCM, scalenes, or supraclavicular retraction)

Tracheal position - should be midline (lateral displacement could occur in tension pneumothorax)

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9
Q

Signs of fingernail clubbing

A

Bulbous swelling of soft tissue at nail base; loss of normal angle between nail and proximal nail fold (>180 degrees) leading to spongy floating feeling

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10
Q

In what conditions might you see nail clubbing?

A

Congenital heart disease

Bronchiectasis

Pulmonary fibrosis

Lung abscess

INFLAMMATORY BOWEL DISEASE

Malignancies (lung cancer)

Cystic fibrosis

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11
Q

Techniques for palpation of the chest

A

Rib motion assessment

Thoracic expansion assessment

Tactile fremitus

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12
Q

When performing percussion in a respiratory exam, dullness replaces resonance when fluid or solid tissue replaces air containing lung or occupies space between percussing fingers. What conditions might this indicate?

A

Lobar pneumonia (alveoli filled with fluid and blood cells)

Pleural accumulation (effusion, hemothorax, empyemia (pus), fibrous tissue or tumor)

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13
Q

Generalied hyperresonance in percussing the lungs may be indicative of what conditions

A

COPD, emphysema, asthma

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14
Q

Unilateral hyperresonance while percussing the lungs may indicate what conditions

A

Large pneumothorax, large air-filled bulla in lung

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15
Q

Diaphragmatic excursion test

What is normal excursion?

A

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

Normal excursion = 3-5.5 cm

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16
Q

Which lung sounds are described below:

Soft and low pitched; heard through inspiration and about 1/3 of expiration, heard over most of lungs (parenchyma)

A

Vesicular

17
Q

Which lung sounds are described below:

Intermediate in intensity and pitch; heard equally in inspiration and expiration, heard best in 1st and 2nd interspaces anteriorly and between the scapulae

A

Bronchovesicular

18
Q

Which lung sounds are described below:

Loud and high pitched, expiratory sounds heard longer than inspiratory, heard best over manubrium (larger proximal airways)

A

Bronchial

19
Q

Which lung sounds are described below:

Very loud and high pitched, heard equally in inspiration and expiration, heard best in the neck

A

Tracheal

20
Q

What would you conclude if bronchovesicular or bronchial breath sounds are heard more distal to expected locations?

A

Air-filled lung has been replaced by fluid filled or solid lung tissue

21
Q

Which lung sounds are described below:

Discontinuous, intermittent, nonmusical, brief

Defined as fine, course, or by timing in respiratory cycle

A

Crackles (rales)

22
Q

Which lung sounds are described below:

Continuous musical quality and prolonged, relatively high pitched, suggestive of narrow airways like in asthma, COPD, and bronchitis

A

Wheezes

23
Q

Which lung sounds are described below:

Relatively low pitched, snoring quality, suggestive of secretions in large airways

A

Rhonchi

24
Q

Which lung sounds are described below:

Wheeze that is entirely or predominantly inspiratory in nature, often louder in neck vs chest wall

A

Stridor

25
Q

What is stridor indicative of

A

Partial obstruction of larynx or trachea (immediate attention needed)

26
Q

Which lung sounds are described below:

Creaking, usually during expiration but can occur in either, usually confined to relatively small area of chest wall

A

Pleural friction rub

27
Q

____________ = spoken words become louder and clearer

A

Bronchophony

28
Q

_________ ________ = whispers are heard louder and clearer during auscultation

A

Whispered pectoriloquy

29
Q

_________ = “ee” sounds like “A”

A

Egophony

30
Q

In patients with fever and cough, the presence of bronchial breath sounds and egophony more than triples the likelihood of ________

A

Pneumonia

PCM I Final (5 decks)

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