PD - Pulm

Question 1

sternal angle of Louis landmark

Answer 1

rib 2

Bifurcation of trachea to bronchi
Carina
T4

Question 2

inferior wing of scapula landmark

Answer 2

rib 7

Question 3

boundaries of the lungs landmarks

Answer 3

Superiorly – 3-4 cm above medial end of clavicle

Inferiorly- to rib 6 at the midclavicular line, rib 8 at the midaxillary line and posteriorly to the level of T9 and T12

Question 4

In both the right and left lungs, the oblique fissure separates the ___________ from the rest of the lung.

The line runs from ____________ to ___________ then posteriorly to the level of ___:

Answer 4

In both the right and left lungs, the oblique fissure separates the lower lobe from the rest of the lung.

The line runs from rib 6 at the midclavicular line to rib 5 at the midaxillary line then posteriorly to the level of T3:

Question 5

At the end of expiration, the diaphragm is at the level of

Answer 5

Rib 5 Anteriorly

T9 Posteriorly

Question 6

Barrel Chest

Answer 6

AP diameter equals or is greater than the lateral diameter; eg. advanced COPD

Question 7

Flail Chest

Answer 7

multiple ribs broken in multiple places, causing that portion of the chest to move paradoxically inward during inspiration

Question 8

Pectus Carinatum

Answer 8

anterior protrusion of sternum; usually does not compromise ventilation

Question 9

Pectus Excavatum

Answer 9

depression of sternum; usually accompanied by mitral valve prolapse

Question 10

Kyphoscoliosis

Answer 10

abnormal AP diameter and lateral curvature of the spine

Question 11

open pneumothorax

Answer 11

Air bubbling from an open wound in the chest; very abnormal

Question 12

I:E Ratio

Answer 12

1:2

Expiration may be prolonged in obstructive states such as Asthma or COPD (I:E Ratio of 1:3 or 1:4)

Question 13

Normal adult respiratory rate

Answer 13

10-14 breaths per minute

Question 14

Bradypnea

Answer 14

abnormal slowed slowed breathing

Question 15

Tachypnea

Answer 15

abnormal increase in breathing

Question 16

apnea

Answer 16

absent breathing

Question 17

Hyperpnea (Kussmaul’s breathing)

Answer 17

increased depth; usually associated with metabolic acidosis

Question 18

Biot breathing

Answer 18

irregular with long periods of apnea; eg. Increased intracranial pressure, drug-induced, brain damage

Question 19

Cheyne-Stokes breathing

Answer 19

irregular with periods of increased and decreased rates and depths and apnea; eg. drug-induced, brain damage

Question 20

evaluation of the degree of symmetry of chest expansion

Answer 20

Place your hands flat on the patient’s back with thumbs parallel to the midline at around the tenth ribs, pulling the skin slightly towards midline.

Ask the patient to inhale deeply and note the symmetry of your chest as your hands expand.

Your hands should move symmetrically with expansion of the chest wall. Localized pulmonary disease may result in lack of symmetry.

Question 21

Tactile Fremitus

Answer 21

vibration felt on the chest wall by the examiner when a pt is speaking

increased density of the lung will increase transmission of sound wave, result in increased tactile fremitus

decreased density (fat, air, or fluid) in the chest cavity –> decreased transmission of sound waves, reduced tactile fremitus

To test: place ulnar side of right hand against one side of the patient’s back, away from the scapulae. Ask the patient to say “ninety-nine”, move hand from side to side and top to bottom to detect difs

Question 22

Flat percussion

Answer 22

high-pitched sound produced from a thick dense mass such as bone or a muscular thigh

Question 23

Dull percussion

Answer 23

low amplitude, short-duration sound produced from a solid organ such as the liver

Question 24

Resonant percussion

Answer 24

higher amplitude, low-pitched sound produced from an air-filled tissue such as the lung

Question 25

Tympanic percussion

Answer 25

high-pitched, hollow sound produced from a hollow, air-filled structure such as stomach

Question 26

Hyperresonant percussion

Answer 26

low-pitched, hollow sound produced from emphysematous lung

Question 27

Normal breath sounds

Answer 27

tracheal bronchial vesicular bronchovesicular

Question 28

adventitious (abnormal) breath sounds

Answer 28

``` rales (crackles) wheezes ronchi stidor pleural rubs ```

Question 29

abnormal transmission of breath sounds

Answer 29

egophany whispered pectoriloquy bronchophony

Question 30

Tracheal (normal breath sound)

Answer 30

harsh, loud, high-pitched sounds heard over trachea; inspiratory and expiratory sounds are equal in length

Question 31

Bronchial (normal breath sound)

Answer 31

loud, high-pitched sounds like air rushing through a tube heard over the manubrium; expiratory is longer and louder than inspiratory; a pause exists between the two components

Question 32

Vesicular (normal breath sound)

Answer 32

soft, low-pitched sounds heard over most lung fields; inspiratory is longer and louder than expiratory

Question 33

Bronchovesicular (normal breath sound)

Answer 33

mixture between bronchial and vesicular sounds heard in the area of the carina and mainstem bronchi; inspiratory and expiratory equal in length; best heard in the first and second interspaces anteriorly and scapulae posteriorly

Question 34

Rales (crackles)

Answer 34

short, discontinuous, nonmusical sounds heard on inspiration (via opening of collapsed distal airways and alveoli) also called rales or crepitation sound is similar to Velcro opening or hair rubbed next to the ear causes: pulmonary edema, CHF, pulmonary fibrosis, pneumonia, atelectasis

Question 35

Wheezes

Answer 35

continuous, musical, high-pitched sounds heard during expiration caused by narrowing of bronchi due to swelling, secretion, foreign body, tumor assoc w/ asthma/COPD and occasionally pulmonary edema and CH (sometimes referred to by the misnomer “cardiac asthma”)

Question 36

Rhonchi

Answer 36

low-pitched; associated with mucus plugging and poor movement of secretions bronchitis

Question 37

Stridor

Answer 37

high-pitched, inspiratory, upper airway sound caused by turbulent flow in the upper airway due to upper airway obstruction such as mass or swelling causes: tumors, croup, foreign bodies

Question 38

Pleural Rubs

Answer 38

grating sound made by pleura that is roughened or thickened by inflammation, neoplasm, or fibrin deposits best heard on inspiration and beginning of expiration; sounds like creaking leather assoc w/ pneumonia and pulmonary infarction

Question 39

Egophany

Answer 39

E --> A spoken word heard through the lungs is increased in intensity and takes on a nasal quality when pt says “eee”, heard as “aaa” in an area of consolidation (eg. fluid-filled)

Question 40

Whispered Pectoriloquy

Answer 40

intensification of a whispered word heard in consolidation of the lung when pt whispers “one-two-three”, normally little or nothing will be heard by the examiner the words will be heard clearly in consolidation of the lung

Question 41

Bronchophony

Answer 41

increased transmission of spoken words when pt says “ninety-nine”, words will be transmitted louder than normally if there is consolidation

Question 42

symptoms of pulmonary disease

Answer 42

``` Cough. Sputum. Hemoptysis (cough up blood). Dyspnea (SOB). Wheezing. Cyanosis. Chest pain. ```