Lung and Thoracic Exam II

Question 1

what questions should you ask during the lung health history?

Answer 1

chest pain
dyspnea (SOB)
wheezing
cough
hemoptysis (spitting up blood)

Question 2

what extrathoracic structures may also cause chest pain

Answer 2

neck
gallbladder
stomach
pancreas (pancreatitis)

Question 3

what thoracic structure is not innervated with sensory nerves?

Answer 3

lung parenchyma

Question 4

dyspnea

Answer 4

abnormal or uncomfortable breathing in the context of that person’s “normal”
unpleasant sensation or difficulty in breathing

Question 5

wheezing

Answer 5

musical respiratory sounds that may be audible

• indicates airway obstruction (secretions, tissue inflammation)
• does not always mean asthma

Question 6

cough

Answer 6

common symptom (trivial-ominous)
reflex response to stimulae that irritate receptors in the larynx, trachea, or large bronchi
typically respiratory but may be cardiac or GI

Question 7

what is often the last symptom to go when a person has an URI

Answer 7

cough

Question 8

why does the cough persist even after the disease is over with?

Answer 8

reactive inflammation of the airway

Question 9

how can GERD cause a cough

Answer 9

acid in esophagus can cause bronchospasm in the airway

Question 10

what should you differentiate in a cough?

Answer 10

dry or moist
productive or non productive
-may be moist but non productive if they can not expectorate any sputum

Question 11

what should you consider with sputum?

Answer 11

volume
color
odor
consistency

Question 12

orthopnea

Answer 12

difficulty breathing while lying down

-described by how many pillows it takes to breathe comfortably

Question 13

mucoid sputum

Answer 13

translucent, white, grey

Question 14

purulent sputum

Answer 14

yellowish, green

Question 15

mycoplasma pneumonia typically has a

Answer 15

dry hacking cough

-atypical pneumonia

Question 16

bronchitis (viral), viral/bacterial pneumonia typically has a

Answer 16

sputum producing cough

Question 17

anaerobic lung abscess typically has

Answer 17

foul smelling sputum

Question 18

cystic fibrosis typically has

Answer 18

tenacious, sticky sputum

Question 19

bronchiectasis or lung abscess typically has

Answer 19

large volumes of sputum

Question 20

where can blood come from that comes out of the mouth?

Answer 20

oral mucosa (lesions)
nose
lungs
GI

Question 21

characteristics of hemoptysis

Answer 21

blood streaked
frank blood (glob of blood)-what size? (quarter, half dollar, dime)

Question 22

hemoptysis

Answer 22

blood that is expectorated from somewhere below the vocal cords (trachea, bronchi)

Question 23

what are the 4 A’s for smoking cessation?

Answer 23

Ask
Advise
Assist
Arrange

Question 24

Steps of the exam

Answer 24

initial survey (breathing, color, accessory muscle use, posture)
exam of posterior chest (sitting)
exam of anterior chest (supine)
special techniques

Question 25

what to observe on palpation

Answer 25

tenderness? abnormalities?
test chest expansion
tactile fremitus (vibration on palpation)

Question 26

tactile fremitus

Answer 26

transmitted through bronchopulomary tree to the chest wall

• use ball or ulnar surface of hand
• say “ninety nine” if faint, speak louder or deeper
• have to have a baseline

Question 27

what does decreased fremitus mean?

Answer 27

obstructed bronchus
COPD
pleural effusion
fibrosis
pneumothorax
some tumors
thick chest wall (obese)

Question 28

when is a good time to do tactile fremitus?

Answer 28

if someone has aspirated something or has some problem that would be only on one side, you would be able to note a decrease in vibration on one side only

Question 29

what does increased fremitus mean?

Answer 29

increased density of tissue (consolidation)

-almost impossible to tell the difference

Question 30

what does percussion do?

Answer 30

produces audible sound and palpable vibration
establishes content of underlying fluid
penetrates 5-7 cm

Question 31

elevated hemidiaphragm

Answer 31

when one side of the diaphragm is higher than the other

Question 32

what is the normal amount of diaphragmatic excursion

Answer 32

5-6 cm

Question 33

bronchophony

Answer 33

say “ninety nine”

normal: sounds should be muffled or indistinct
abnormal: louder, clearer sounds (something is helping sound to transmit more readily through the chest wall)
- while auscultating

Question 34

egophony

Answer 34

say “ee”

normal: hear a long e sound
abnormal: “ee” sounds like “ay”
- while auscultating

Question 35

whispered pectoriloquy

Answer 35

whisper “ninety nine”

normal: sounds heard faintly, if at all
abnormal: loud, clear sounds

Question 36

a percussed lung that gives a flat sound could indicated

Answer 36

large pleural effusion

Question 37

a percussed lung that gives a dull sound could indicate

Answer 37

a lobar pneumonia

Question 38

a percussed lung that gives a normal resonant sound could indicate

Answer 38

simple chronic bronchitis

Question 39

a percussed lung that gives a hyperresonant sound could indicate

Answer 39

emphysema, pneumothorax

Question 40

a percussed lung that gives a tympany sound could indicate

Answer 40

large pneumothorax