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Clinical Skills > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

what is a normal RR?

A

14-20 breaths per min

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2
Q

tachypnea

A

> 25 breaths/min

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3
Q

true or false- the intercostal space is the same number as the rib above

A

true

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4
Q

what is the most prominent bony landmark of the posterior neck?

A

spinous process of C7

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5
Q

this line is halfway between the clavicles

A

midclavicular

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6
Q

this line overlies the spinous process of the vertebrae

A

vertebral line

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7
Q

this line drops from the inferior angle of the scapula

A

scapular line

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8
Q

the inferior tip of the scapular lies about at the level of the _____ rib

A

7th

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9
Q

true ribs

A

1-7

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10
Q

false ribs

A

8-10

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11
Q

floating ribs

A

11 and 12

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12
Q

this is where the lower border of the rib is anteriorly

A

6th rib at the MCL
8th rib at the MAL

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13
Q

this is where the lower border of the rib is posteriorly

A

T10 spinous process

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14
Q

this fissure splits each rib in half

A

oblique

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15
Q

approximation of oblique fissure location

A

T3 spinous process to the 6th rib at the MCL (midclavicular line)

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16
Q

the right lung has this extra fissure which becomes the superior border of the right middle lobe

A

horizontal fissure

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17
Q

horizontal fissure approximate location

A

4th rib and meets oblique fissure around MAL near 5th rib

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18
Q

where does the trachea bifurcate?

A

sternal angle anteriorly and T4 posteriorly

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19
Q

which pleural layer hurts when inflamed?

A

parietal

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20
Q

this layer lines the inner thoracic cage and superior surface of the diaphragm

A

parietal pleura

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21
Q

this layer covers the surface of the lung

A

visceral

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22
Q

where to insert for tension pneumothorax

A

2nd intercostal space

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23
Q

where to insert for anterior chest tube placement

A

4th intercostal space

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24
Q

where to insert for ET tube tip placement

A

T4- nipple line (lower margin)

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25
Q

true or false- always poke inferior to rib margin

A

FALSE- always poke superior to avoid the intercostal bundle (VAN)

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26
Q

in ______ position, abdominal movements are easier to see than the thoracic respiratory movements

A

supine

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27
Q

in the ______ position, thoracic movements are more prominent than abdominal respiratory movements

A

seated

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28
Q

exercise and respiratory disease lead to the recruitment of ________ muscles

A

accessory (scalenes and SCMs)

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29
Q

is inspiration or expiration an active process?

A

inspiration

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30
Q

what are you inspecting for in the respiratory section of the PE?

A

RR
rhythm, depth, effort
color
shape of chest
use of accessory muscles
asymmetry of expansion
trachea midline
audible noises
skin abnormalities

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31
Q

this occurs when the anteriorposterior diameter of the chest increases (age and respiratory diseases)

A

barrel chest

32
Q

“hump back”

A

kyphosis

33
Q

this refers to when the sternum sticks out

A

pectus carinatum

34
Q

this refers to when the sternum caves in

A

pectus excavatum

35
Q

this refers to when the skin of the thorax is separated and moves inversely

A

flail chest

36
Q

this is high pitched inspiratory whistling and may be due to upper airway obstruction

A

stridor

37
Q

this is an audible noise made on expiration

A

wheezing

38
Q

this is crackling or grinding over bones or joints

A

crepitus

39
Q

where should you place your thumbs for chest expansion?

A

level of 10th ribs

40
Q

what could asymmetry on lung excursion indicate?

A

pleural effusion
splinting from pain
chronic fibrosis
unilateral airway obstruction
paralysis of hemidiaphragm

41
Q

this is palpable vibrations transmitted through the bronchopulmonary tree to the chest wall as the patient is speaking

A

fremitus

42
Q

where is fremitus best heard?

A

interscapular space

43
Q

what part of the hand should be used for tactile fremitus?

A

ball of hand or ulnar surface

44
Q

_________ (+/-) fremitus occurs with excessive amounts of air in the lungs or increased distance to chest wall

ex- pleural effusion, pneumothorax, asthma, COPD, decreased transmission of low freq sounds

A

decreased

45
Q

_________ (+/-) fremitus occurs in penumonia tumor and leads to increased transmission through consolidated tissue

A

increased

46
Q

this technique of the respiratory exam helps identify if the underlying tissue if air or fluid filled or solid.

A

percussion

47
Q

percussion technique

A

left DIP joint (pleximeter finger) firm on pt surface
R 3rd digit strikes with pad of finger (plexor)

48
Q

this structure on percussion sounds flat and is similar sounding to a large pleural _______

A

thigh; effusion

49
Q

dullness on percussion signifies what?

A

fluid or solid

50
Q

what is dull on percussion?

A

liver
lobar pneumonia
empyema
pleural effusions
hemothorax
fibrous tissue
tumor

51
Q

this is what healthy lungs sound like on percussion

A

resonant

52
Q

this is what hyperinflated lungs sound like
emphysema, asthma, unilateral pneumothorax

A

hyperresonant

53
Q

this sound is more than hyperresonant on percussion
gastric air bubble, puffed out cheek, large pneumothorax

A

tympanic

54
Q

this test identifies the distance of the diaphragm dissention into the thorax during full inspiration

A

diaphragmatic excursion

55
Q

what is a normal distance of diaphragmatic excursion?

A

3- 5.5 cm

56
Q

what landmark do you do diaphragmatic excursion on?

A

midclavicular line

57
Q

this is the most important exam technique for assessing air flow through the tracheobronchial tree

A

auscultation of the lungs

58
Q

when performing lung auscultation, should you use the bell or diaphragm?

A

diaphragm

59
Q

true or false- you should listen to one full breath in each ladder position when auscultating the lungs

A

true

60
Q

what should be listened for during respiratory auscultation?

A

pitch
intensity
duration of inspiration and expiration

61
Q

this type of normal breath sound is heard over both lungs, is low and soft, and lasts longer in inspiration

A

vesicular

62
Q

this sound is often in the 1st and 2nd intercostal spaces anteriorly and between the scapula and inspiratory and expiratory sounds are almost equal

A

broncho-vesicular

63
Q

this breath sound is heard over the manubrium, is high and loud, and expiratory lasts longer than inspiratory

A

bronchial

64
Q

this breath sound is heard over the trachea in the neck, is high and very loud and inspiratory and expiratory are almost equal

A

tracheal

65
Q

these lung sounds are discontinuous, intermittent, brief and may be fine or coarse

A

crackles/ rales

66
Q

this lung sound is continuous, musical, prolonged, low pitched with snoring quality and suggests secretions in large airways

A

rhonchi

67
Q

this lung sound is high pitched with hissing or shrill quality and suggests airway narrowing (asthma, bronchitis)

A

wheezes

68
Q

when to perform bronchophony

A

when bronchovesicular or bronchial sounds are heard

69
Q

how to perform bronchophony

A

listen in all 14 ladder positions while having pt say “99”

70
Q

on bronchophony, are clearly heard sounds good or bad?

A

BAD

71
Q

true or false- egophony does not occur in pneumonia

A

false

72
Q

true of false- the dullness of a middle lob pneumonia typically occurs behind the right breast

A

true

73
Q

this pulmonary function test measures the distance a patient can walk on a flat hard surface in 6 min
(used mostly for COPD outcomes)

A

6 min walk test

74
Q

this pulmonary function test measures how quickly a pt can expire and the clinical should listen over the trachea with the diaphragm

A

forced expiratory time

75
Q

pts with >60 y/o w/ FET >9 sec are ____ times as likely to have COPD

A

4 x

Clinical Skills (6 decks)

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