Pulmonary

Question 1

Lungs, fissures, lobes

Answer 1

Each lung is divided roughly in half by oblique fissure

R lung divided by horizontal minor fissure
R lung divided into upper, middle, and lower lobes
L lung divided into upper and lower lobes

Trachea- bifurcated into mainstem bronchi at sternal angle and T4

Pleurae- serous membranes that cover surface of each lung (visceral pleura)
Inner rib cage and upper surface (parietal pleura)

Question 2

Chest pain

Answer 2

Lung tissue does not have pain fibers. Pain in lung arises from inflammation of adjacent parietal pleura. Surrounding structures can irritate parietal pleura

Question 3

SOB (dyspnea)

Answer 3

Non-painful, uncomfortable awareness inappropriate for level of exertion
“Have you had any difficulty breathing?” Determine severity based on patient’s daily activities

Wheezing musical respiratory sounds may be audible to patient and others

Cough- reflex response to stimuli that irritate receptors in larynx. Can have cardio origin

Question 4

Hemoptysis***** TQ!!

Answer 4

Coughing up blood from lungs. Blood-streaked phlegm to frank blood. Like sputum. Can originate from mouth, pharynx, or GI tract

Question 5

Pulmonary Examination

Answer 5

Inspect, Palpate, Percuss, and Auscultate

Question 6

Vesicular** TQ!

Answer 6

soft and low pitches; usually heard over most of both lungs. Gentle rushing (normal lung sound)

Question 7

Bronchial

Answer 7

Louder and higher in pitch. Tubular

• over manubrium

Question 8

Bronchovesicular

Answer 8

Intermediate intensity and pitch; Rustling but tubular

• over 1st and 2nd interspaces and scapula on posterior

Question 9

Tracheal

Answer 9

Very loud, very high pitch, very harsh

• over trachea in neck

Question 10

Egophany, whispered pectoriloquey, and bronchophony are increased with

Answer 10

Consolidation - liquid instead of air

Question 11

Lobes relation to chest wall

Answer 11

Anterior: RUL, RML, LUL, LLL

Posterior: lLUL, LLL, RUL, RLL (not right middle)

Lateral: RUL, RML, RLL, LUL, LLL (all)

Question 12

Trachea’s position

Answer 12

Bifurcates into mainstem bronchi at sternal angle and T4, midline

Question 13

Pectus excavatum

Answer 13

Funnel chest, depression in lower part of sternum. Compression of heart or vessel cause murmurs

Question 14

Barrel chest

Answer 14

Increase AP diameter. Accompanies aging and COPD

Question 15

Dyspnea

Answer 15

SOB

Question 16

Diagnostic meaning of abnormal tactile fremitus

Answer 16

Fremitus decrease/absent when voice is soft, or transmission of vibrations is blocked
Causes- thick chest wall, blocked bronchus, COPD, pleural effusion, fibrosis, air, tumor

Asymmetric decreased fremitus-unilateral pleural effusion, pneumothorax.
Asymmetric increased fremitus- unilateral pneumonia.

Question 17

Diaphragmatic excursions

Answer 17

Abnormally high indicative of pleural effusion, atelectasis, diaphragmatic paralysis

Question 18

Percussion sounds

Answer 18

Healthy lungs- resonant
Abnormal lungs-
- Dullness: left lower thorax
- Hyper-resonance: pneumothorax ***** TQ!
- Flatness, tympani: absent breath sounds

Question 19

Crackles ***** TQ

Answer 19

Crackles- discontinuous, intermittent brief. Occur at late inspirations, early inspiratory, mid-inspiratory, and expiratory crackles.***** TQ!

Question 20

Fine crackles

Answer 20

Fine crackles- soft, high pitched, brief

Question 21

Coarse crackles

Answer 21

Louder, lower in pitch brief

Dx meaning- problem with lungs/airway. Pneumonia, early CHF, bronchitis

Question 22

Pleural rub

Answer 22

Inflamed pleural surfaces grating against each other

Increased friction produce creaking sounds

Question 23

Mediastinal crunch

Answer 23

Hamman’s sign- crackles with heartbeat, not respiration. Due to mediastinal emphysema

Question 24

Wheezes**** TQ!

Answer 24

Continuous, high pitched hissing/shrill ***** TQ!
Audible at mouth through chest wall
Dx meaning- narrowed airways, asthma, COPD, bronchitis

Silent chest- airway so narrow, wheezing can’t be produced

Question 25

Stridor

Answer 25

Wheeze during inspiration | Dx meaning- partial obstruction of larynx or trachea

Question 26

Rhonchi ***** TQ!!!

Answer 26

Continuous, musical, low snoring ****** | Dx meaning - secretions in large airways

Question 27

Pneumothorax causes absent breath sound at what level

Answer 27

T1-T5/T6

Question 28

Accessory muscles for breathing

Answer 28

SCM, scalenes, pec minor. Look for bulging neck muscles, use of muscles one side of the chest, heaving abdomen

Question 29

Anterior location of lower border of lung

Answer 29

6th rib, midclavicular line and 8th rib - midaxillary line

Question 30

Posterior location of lower border of lung

Answer 30

T10 spinous process

Question 31

Trachea bifurcation

Answer 31

Sternal angle anterior and T4 spinous process posteriorly

Question 32

Location of bronchovesicular breath sounds

Answer 32

1st and 2nd interspaces anteriorly between the scapulae

Question 33

In a patient with pneumonia, you would expect percussion of the left lower thorax to be

Answer 33

Dull (resonant —-> dull)

Question 34

In a pt with pneumonia, egophany would produce an ______ to _______ transition

Answer 34

E to A

Question 35

COPD, you would find increased ___________

Answer 35

AP diameter

Question 36

Upon auscultation in a pt with COPD, you would expect to hear

Answer 36

Delayed expiratory phase

Question 37

Pneumothorax would produce

Answer 37

Increased resonance (hyperresonance on affected side) Bc more air, would also occur with emphysema

Question 38

In a pt with pneumothorax, auscultation

Answer 38

Absent breath sounds

Question 39

In a healthy adult, expected distance of descent of diaphragm is

Answer 39

5-6 cm

Question 40

Normal respiratory rate

Answer 40

14 to 20 breaths per minute