Lower Respiratory (Ribs, Lungs, Respiration)

Question 1

Where would you perform needle decompression?

Answer 1

2nd intercostal space just superior to the 3rd rib margin (to avoid neurovascular bundle)

Question 2

Where would you insert a chest tube?

Answer 2

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

Question 3

What would correspond to T4 on a chest x-ray?

Answer 3

The lower margin of endotracheal tube

Question 4

What is the 7th intercostal space a landmark for?

Answer 4

thoracentesis

Question 5

A decreased or absent fremitus (palpable vibration) would be found in what pathological conditions?

Answer 5

COPD, pleural effusions, fibrosis, pneumothorax, or an infiltrating tumor

Question 6

An increased fremitus (palpable vibrations) would be found in what pathological conditions?

Answer 6

Pneumonia - increased transmission thru consolidated tissue

Question 7

What is stridor?

Answer 7

A wheeze that is entirely or predominantly inspiratory in nature - requires immediate medical attention

Question 8

What is Bronchophony?

Answer 8

When spoken words (“ninety-nine”) become louder and clearer (stethoscope listening on back) - this is bad since normal sounds are muffled

Question 9

What is Egophony ?

Answer 9

Patient says “ee” and it sounds like an “A” instead; positive egophany test triples the likelihood of pneumonia in patients who have fever and cough.

Question 10

what is Whispered pectoriloquy?

Answer 10

Whispered sounds (“ninety-nine” or “one, two, three”) are clearer during auscultation – this is bad b/c you typically can’t hear whispered sounds

Question 11

What are vesicular sounds referring to, and how should they sound?

Answer 11

Vesicular = most of lung tissue (parenchyma)

Sound: Soft, low pitched, heard thru inspiration and 1/3 of way thru expiration

Question 12

What are bronchial / tracheal sounds referring to, and how should they sound?

Answer 12

Bronchial = trachea / cartilage airway tubing
Tracheal = trachea, specifically high up in neck

Sound: Loud and high pitched, expiratory sounds are heard longer than inspiratory sounds –> best heard over manubrium

Question 13

What are bronchiovesicular sounds referring to, and how should they sound?

Answer 13

Bronchiovesicular = bronchi and bronchiole area

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