Lung Exam

Question 1

Trachea bifurcates ?

Answer 1

at the carina at levels of sternal angle anteriorly and T4 spinous process posteriorly

Question 2

Apex of the lung location?

Answer 2

2-4 cm above the inner 1/3 of clavicle

Question 3

Anterior-lower border location?

Answer 3

Crosses the 6th rib at midclavicular line & the 8th rib at mid axillary line

Question 4

Posterior-lower border location?

Answer 4

Lies about level of T10 spinous process

Question 5

oblique fissure

Answer 5

Divides both lungs roughly in half

T3 spinous process obliquely down & around chest to 6th rib at midclavicular line

Question 6

horizonatal fissure

Answer 6

R. lung only

Runs close to 4th rib & meets oblique fissure in midaxillary line near 5th rib

Question 7

Signs in the right upper lung field?

Answer 7

Most certainly originate in RUL

Question 8

Signs in right middle lung field laterally

Answer 8

Could come from any of three different lobes

Question 9

Increased Tactile Fremitus

Answer 9

vibration from larynx to chest in enhanced as when consolidation is present (ie. pneumonia)

Question 10

Tactile Fremetus decreased or absent

Answer 10

vibration from larynx to chest surface impeded (ie. COPD, obstruction, pleural effusion or pneumothorax)

Question 11

Percussion: Flatness

Answer 11

Theigh

Question 12

Percussion: Dullness

Answer 12

Liver
Replaces resonance in a consolidated or fluid lung

Heart produces area dullness to left of sternum from 3rd-5th ICS

Dullness of RML pneumonia typically occurs behind right breast

Question 13

Percussion: Resonance

Answer 13

Normal Lung

Question 14

Percussion: Hyperresonance

Answer 14

None normally

Question 15

Percussion: Tympany

Answer 15

Gastric Bubble or puffed out cheeks

Question 16

Diaphragmatic Excursion

Answer 16

Normal 5-6cm

if level is high, suggests pleural effusion or high diaphragm

Question 17

Wheeze/Rhonchi

Answer 17

Sibilant rhonchi
Wheeze-relatively high pitched (>400 Hz) with hissing or shrill quality
Sonorous rhonchi
Rhonchi- relatively low pitched (

Question 18

Stridor

Answer 18

Wheeze that is predominately or entirely in inspiration
Louder in neck than chest wall
Indicates partial obstruction of larynx or trachea

Question 19

Crackles/Rales

Answer 19

Discontinuous
Intermittent, nonmusical, & brief
Fine crackles-soft, high pitched, very brief (5-10msec)
Coarse crackles-somewhat louder, lower pitched, brief (20-30 msec)

Inspiration—early vs. late

Question 20

Pleural Rub

Answer 20

Resemble crackles by sound
Often discrete but if numerous can seem continuous
Typically confined to small area of chest wall
Heard in both phases of respiration