Phsyical assessment of Pulmonary system lecture

Question 1

which of the 4 cornerstones are used in the pulmonary exam?

Answer 1

Inspection
palpation
percussion
auscultation

Question 2

Where can we get the closest to the lung tissue?

Answer 2

the intercostal space

Question 3

What is a good starting point for determining clinical anatomy?

Answer 3

suprasternal notch

Question 4

What is located 5cm below the suprasternal notch?

Answer 4

the sternal angle (angle of Louis)

Question 5

What intercostal space is located at the same level and the sternal angle?

Answer 5

2nd

Question 6

What is marker for the beginning of the posterior chest wall?

Answer 6

the C-7 spinous process.

Question 7

Which lobes can you auscultate anteriorly?

Answer 7

RUL, RML, LUL

Question 8

Where can you auscultate the Lower Lobes anteriorly?

Answer 8

LLL and RLL are located at the costophrenic angle

Question 9

What lobes can you osculate posteriorly?

Answer 9

LLL and RLL (uppers as well)

Question 10

systemic signs of pulmonary dz.

Answer 10

cyanosis
clubbing
barrel chest
tripod position

Question 11

signs of respiratory distress

Answer 11

Rate and effort
accessory muscle use
Unusual respiratory noises

Question 12

What do you inspect anteriorly?

Answer 12

trachea midline
obvious deformities
asymmetry
trauma

Question 13

pectus carinatum

Answer 13

pigeon chest (convex)

Question 14

Pectus excavatum

Answer 14

funnel chest (concave)

Question 15

Pectus excavatum

Answer 15

funnel chest (concave)

Question 16

inspection of posterior chest

Answer 16

deformities
asymmetry
abnormal retractions

Question 17

Palpation of chest

Answer 17

Any abnormalities seen on inspection.

Symmetric chest expansion

Question 18

causes of asymmetric chest expansion

Answer 18

pna
bronchial obstruction
pleural effusion
pain (splinting

Question 19

Decreased tactile fremitus indicates

Answer 19

bronchial obstruction
pleural effusion
Pleural fibrosis
COPD
PTX
tumor
unusual thick chest wall

Question 20

Increased tactile fremitus indicates:

Answer 20

pneumonia

Question 21

percussion note for pleural effusion

Answer 21

dull/flat depending on size

Question 22

Percussion note for consolidation (edema/pna)

Answer 22

dull over area of decreased aeration

Question 23

percussion note for atelectasis

Answer 23

dull over atelectasis

Question 24

percussion note for normal lung tissue

Answer 24

resonant

Question 25

percussion note for ptx

Answer 25

hyperresonant or tympanic if large

Question 26

percussion note for COPD

Answer 26

hyperresonant diffusely

Question 27

percussion note for Asthma

Answer 27

hyperresonant

Question 28

what 3 things are you listening for on ausculation?

Answer 28

Lung sounds
Presence of adventitious sounds
when abnormal-sound of whispered word

Question 29

What must you ALWAYS ask pt to do when auscultating?

Answer 29

breathe through mouth.

Question 30

Vesicular sounds

Answer 30

soft and low
throughout inspiration but fade after 1/3 expiration.
throughout lungs

Question 31

Bronchovesicular sounds:

Answer 31

Louder than vesicular sounds
Heart equally insp. and exp. usually separated by interval
Heart best at 1 and 2 ICS anterior, and between scap posterior

Question 32

Bronchial sounds:

Answer 32

very loud high pitched sounds
Exp sounds longer
heart best over manibrium

Question 33

3 types of adventitious sounds

Answer 33

Rhonchi
Wheezes
Crackles (Rales)

Question 34

Rhonci

Answer 34

low pitched - snoring/geese honking-secretions in large airways

Question 35

Wheezes

Answer 35

High pitched, shrill, inspiratory/expiratory, assoc. w/ asthma, COPD, bronchitis
Stridor-long inspiratory wheeze

Question 36

Crackles

Answer 36

fine-high pitched brief duration (suddenly pop open during late inspiration!!
Coarse-Low pitched louder longer duration-alveoli bubbles through secretions early inspiration!!
NOTE WHAT PHASE OF BREATHING YOU HEAR THE CRACKLES!

Question 37

Pleural friction rub

Answer 37

inflamed pleural spaces