Lower Respiratory Tract

Question 1

Needle thoracentesis (decompression)

Answer 1

2nd intercostal space, midclavicular line

Question 2

Chest tube insertion

Answer 2

4th or 5th intercostal space, just anterior to midaxillary line

Question 3

Neurovascular bundle

Answer 3

Runs along the inferior margins of each rib. Chest tubes & needles need to be placed over the superior margin of the rib to avoid the bundle

Question 4

pulse oximetry

Answer 4

measures peripheral arterial oxygen saturation, known as “fifth vital sign”
bad waveform–improper placement, hypoperfusion, hypothermia, motion artifact

Question 5

End tidal CO2

Answer 5

The concentration of CO2 in exhaled air at the end of respiration
Normal PaCO2– 35-40 mmHg

Question 6

Incentive Spirometer

Answer 6

used to keep lungs healthy after surgery or after a respiratory illness
Training to take slow, deep breaths.
As you breath in with mouth around the mouthpiece, the ball inside the large column will move up. Try to move it as high as you can, or to the level recommended by Dr.

Question 7

Atelectasis

Answer 7

The loss of lung volume due to collapse of lung tissue (alveoli)

• -can be seen post-surgery
• -Incentive spirometer can help

Question 8

Pulmonary Function Test

Answer 8

Non-invasive, diagnose certain lung disorders (obstructive vs restrictive)

Question 9

Spirometry

Answer 9

measures lung function

amount & speed of air inhaled/exhaled

Question 10

asymmetrical expansion of the chest wall

Answer 10

pleural effusion

Question 11

retraction of chest wall

Answer 11

severe asthma, COPD, or upper airway obstruction

Question 12

Tracheal deviation

Answer 12

can be seen in pneumothorax, pleural effusion, atelectasis, & mass

Question 13

Causes of clubbing

Answer 13

congenital heart disease, interstitial lung diseases, bronchiectasis, pulmonary fibrosis, cystic fibrosis, lung abscess, malignancy (lung cancer), inflammatory bowel disease

Question 14

Pectus excavatum

Answer 14

“funnel chest”

depression in lower portion of the sternum. Can compress heart & great vessels & cause murmurs

Question 15

Pectus Carinatum

Answer 15

“pigeon chest”

Sternum displaced anteriorly (increased AP diameter), adj costal cartilages are depressed

Question 16

Barrel Chest

Answer 16

Increased AP diameter resembling a barrel, seen in COPD

Question 17

Chronic bronchitis

Answer 17

clinical diagnosis: daily productive cough for 3 months or more, in at least 2 consecutive yrs, elevated hemoglobin, peripheral edema, rhonchi & wheezing, overweight & cyanotic

Question 18

Emphysema

Answer 18

Pathologic diagnosis: permanent enlargement & destruction of airspaces distal to the terminal bronchiole, older & thin, severe dyspnea, quiet chest, hyperinflation with flattened diaphragms on XR

Question 19

Traumatic flail chest

Answer 19

multiple rib fractures may result in paradoxical movements of the thorax–area caves inward on inspiration & outward on expiration

Question 20

Thoracic expansion

Answer 20

place thumbs @ level of 10th ribs, fingers loosely grasping lateral rib cage
ask pt to inhale deeply & watch distance between your thumbs to look for symmetry

Question 21

Decreased or absent tactile fremitus

Answer 21

COPD, pleural effusion, pleural fibrosis, infiltrating tumor, pneumothorax

Question 22

increased tactile fremitus

Answer 22

pneumonia (consolidation)

Question 23

Percussion tones

Answer 23

Flat over heavy muscles or bones, cardiac dullness, liver dullness
resonance over lungs

Question 24

Dullness replaces resonance upon percussion

Answer 24

fluid or solid tissue replaces air-containing lung
lobar pneumonia (alveoli filled w fluid or blood cells)
pleural accumulations–effusion, hemothorax, empyema (pus)

Question 25

Generalized hyperresonance upon percussion

Answer 25

heard over hyperinflated lungs
COPD
asthma

Question 26

unilateral hyperresonance upon percussion

Answer 26

large pneumo

large air-filled bullae (space) in lung

Question 27

asymmetry with diaphragmatic excursion

Answer 27

pleural effusion

high diaphragm secondary to atelectasis or phrenic nerve paralysis

Question 28

Abnormal vocal resonance

Answer 28

Distinctness increases with lung consolidation (tumor, pneumonia, effusions)

bronchoscopy–spoken words get louder
whispered pectoriloquy–whispered words are louder& clearer during auscultation
egophony–when pt says “ee” it sounds like “A”

Question 29

Cheyne-stokes respirations

Answer 29

abnormal pattern of breathing characterized by progressively deeper, and sometimes faster, breathing followed by a gradual decrease that results in a temporary stop in breathing called apnea.

Question 30

Kussmaul respirations

Answer 30

Kussmaul breathing is a deep, labored breathing pattern that indicates metabolic acidosis–a form of hyperventilation. Often seen in DKA

Question 31

accessory muscles of breathing

Answer 31

scalenes
sternocleidomastoids
intercostal muscles
subcostal muscles