Pulm

Question 1

Whisper pectoriloquy

Answer 1

-you can hear it if abnormal
-normal you cant hear

Question 2

bronchophony

Answer 2

-louder sound

Question 3

egophony

Answer 3

-E sounds like A
-do if crackles
-pneumonia
-pleural effusion

Question 4

tactile fremitus

Answer 4

-DECREASE
-obstructed bronchus
-COPD
-pleural effusion
-fibrosis
-pneumothorax
-tumor
-asthma

-INCREASED
-pneumonia
-atelectasis (at the collapsed site)

Question 5

percuss for diaphragm

Answer 5

-posterior only
-3-5.5cm normal

Question 6

locating findings on chest

Answer 6

-vertical axis- rib/ICS
-circumference of chest
-midsternal
-midclavicular
-anterior axillary
-midaxillary
-posterior axillary
-scapular
-vertebral

Question 7

lung lobes

Answer 7

-right lung- horizontal and oblique -> upper, middle, lower
-left lung- oblique -> upper and lower

Question 8

where is the bifurcation of trachea

Answer 8

-2 main stem bronchus
-anterior- T2
-posterior T4

Question 9

parietal pleura inflammation

Answer 9

-pain in chest
-lung tissue itself has no pain fibers
-point to pain sitting and laying down
-ask general question- discomfort?
-costochondritis, esophageal spasm, herpes

Question 10

SOB

Answer 10

-is the pt sedentary? -> subconsciously modify lifestyle

Question 11

adventitious lung sounds

Answer 11

-wheezing- musical, with or without stethoscope
-coughing- reflex to larynx, trachea, large bronchi, cardio, GI
-cough- left HF
-crackles (bubbles)
-rhonchi- snore -> bronchitis
-velcro- interstitial

Question 12

smoking

Answer 12

-5 As
-Ask each visit
-Advise
-Assess readiness to quit
-Assist- set goals, educate
-Arrange f/u to monitor and support

Question 13

chest expansion

Answer 13

-10th rib
-asymmetric- pleural effusion
-unilateral impairement/lagging- asbestosis, silicosis, phrenic nerve damage, paralysis of hemidiaphragm, chronic fibrosis, lobar pneumonia

Question 14

of places to check

Answer 14

TACTILE FREMITUS
-anterior- 3
-posterior- 4

PERCUSSION
-anterior- 6
-posterior- 7

AUSCULTATION
-anterior- 6
-posterior- 7

Question 15

percussion

Answer 15

-flatness
-dullness- pneumonia, pleural effusion
-resonance- NORMAL
-hyperresonance- COPD, asthma, pneumothorax, bulla
-tympany- air
-air, fluid, solid
-heart- dullness to left of sternum from 3rd-5th ICS

Question 16

breath sounds

Answer 16

-vesicular- soft and low pitch -> most of lung
-bronchial- louder and higher pitch -> manubrium
-bronchial breath sounds hear over a pneumonia
-bronchovesicular- intermediate intensity and pitch -> 1st and 2nd ICS
-tracheal- trachea
-adventitious (added) sounds- crackles (bubbles), wheezes, rhonchi

Question 17

chest abnormality

Answer 17

-barrel- COPD, air trapping
-flail- paradoxical
-pectus excavatum- can compress heart
-pigeon- carinatum- costcochrondra can be depressed

Question 18

screening

Answer 18

-cancer- annual with LDCT in 50-80yo who have 20 pack year hx and currently smoke or quit within past 15 years
-latent TB screen- increase risk pts
-sleep apnea- NONE

Question 19

sputum

Answer 19

-mucoid- clear- viral, cystic fibrosis
-purulent- bacterial pneumonia
-foul smelling- anaerobic lung abscess, bronchiectasis

Question 20

tachypnea

Answer 20

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