Lower Respiratory OSCE Flashcards
Anatomical landmarks during inspection of the chest
Sternal angle - where second rib meets with manubrium and sternal body
Suprasternal notch
Xiphoid process
Scapula
Thoracic vertebrae
Landmarks for needle decompression
2nd intercostal space just superior to the 3rd rib margin at the midclavicular line for emergent decompression tension pneumothorax, followed by chest tube placement
Landmarks for chest tube insertion
4th intercostal space at mid or anterior axillary line in the 4th intercostal space just superior to the margin of the 5th rib
T___ = lower margin of endotracheal tube on CXR
4
Landmark for thoracentesis
7th intercostal space
Normal respiratory rate
14-20x/min
Pursed lips while breathing is indicative of what condition
COPD
Why would you inspect the neck during respiratory exam?
Contraction of accessory muscles (SCM, scalenes, or supraclavicular retraction)
Tracheal position - should be midline (lateral displacement could occur in tension pneumothorax)
Signs of fingernail clubbing
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
In what conditions might you see nail clubbing?
Congenital heart disease
Bronchiectasis
Pulmonary fibrosis
Lung abscess
INFLAMMATORY BOWEL DISEASE
Malignancies (lung cancer)
Cystic fibrosis
Techniques for palpation of the chest
Rib motion assessment
Thoracic expansion assessment
Tactile fremitus
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?
Lobar pneumonia (alveoli filled with fluid and blood cells)
Pleural accumulation (effusion, hemothorax, empyemia (pus), fibrous tissue or tumor)
Generalied hyperresonance in percussing the lungs may be indicative of what conditions
COPD, emphysema, asthma
Unilateral hyperresonance while percussing the lungs may indicate what conditions
Large pneumothorax, large air-filled bulla in lung
Diaphragmatic excursion test
What is normal excursion?
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
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)
Vesicular
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
Bronchovesicular
Which lung sounds are described below:
Loud and high pitched, expiratory sounds heard longer than inspiratory, heard best over manubrium (larger proximal airways)
Bronchial
Which lung sounds are described below:
Very loud and high pitched, heard equally in inspiration and expiration, heard best in the neck
Tracheal
What would you conclude if bronchovesicular or bronchial breath sounds are heard more distal to expected locations?
Air-filled lung has been replaced by fluid filled or solid lung tissue
Which lung sounds are described below:
Discontinuous, intermittent, nonmusical, brief
Defined as fine, course, or by timing in respiratory cycle
Crackles (rales)
Which lung sounds are described below:
Continuous musical quality and prolonged, relatively high pitched, suggestive of narrow airways like in asthma, COPD, and bronchitis
Wheezes
Which lung sounds are described below:
Relatively low pitched, snoring quality, suggestive of secretions in large airways
Rhonchi
Which lung sounds are described below:
Wheeze that is entirely or predominantly inspiratory in nature, often louder in neck vs chest wall
Stridor
