Pulmonary Exam Flashcards
You count the ribs by looking first for the _____
Sternal angle
Having a ____ approach to the exam will help you to perform all aspects of the exam without skipping portions.
systematic
In an initial survey, observe the patient’s _____ of breathing
respiratory rate, rhythm, depth, and effort
From a midline position in front of or behind the patient, note the ____ of the chest and how the chest moves.
shape
Clubbing Can be indicative of a _____
chronic lung disease
Inspect the neck for any signs of _____
accessory muscle contraction.
- Sternomastoid
- Scalenes
The A-P diameter can increase with ____, or may be a sign of ______
aging; chronic obstructive lung disease.
Acute tenderness to palpation over pectoral muscles or at the costal cartilage support, but do not prove, that the chest pain has a _____
musculoskeletal origin
When testing chest expansion, place your thumbs at approximately the level of the _____ rib posteriorly (or at inferior sternum anteriorly).
10th
Several pathologic conditions can cause unilateral decreased chest expansion, or a delay in chest expansion, including:
Chronic Pulmonary Fibrosis
Pleural effusion
Significant lobar pneumonia
Pneumothorax
Unilateral bronchial obstruction
Fremitus refers to the _____ transmitted through the bronchopulmonary tree to the chest wall as the patient speaks.
palpable vibrations
Conditions that make the lung more solid so vibrations are transmitted more easily (Increased fremitus)
Pneumonia
Pulmonary edema (within alveoli)
Heavy bronchial secretions
Solid mass within the lung
Conditions that make the lung less solid or pull the lung away from the thoracic wall. (Decreased fremitus)
Overexpansion (like emphysema)
Pneumothorax
Pleural effusion
Increased body fat
_____ helps you establish whether underlying tissues are air-filled, fluid-filled, or solid.
Percussion
An abnormally high level of dullness on one side when completing a diaphragmatic excursion test might suggest
A large pleural effusion
Auscultation involves
- Listening to sounds generated by breathing
- Listening for adventitious sounds
- If abnormalities are suspected, listening to patient’s spoken or whispered voice
Adventitious (Added) Sounds are abnormal sounds superimposed on the usual breath sounds and include
Wheezing
Crackles (Rales)
Rhonchi
(Stridor and Pleural friction rubs also abnormal)
T/F - Inspiratory and Expiratory sounds are about equal in pitch, intensity, and duration in Tracheal Breath sounds.
T
Bronchial breath sounds are best heard where?
over the manubrium and in the first and second interspaces.
Where do Expiratory sounds last slightly longer than the Inspiratory sounds?
Bronchial Breath sounds
The pitch of _______ is relatively low compared to tracheal and bronchial sounds.
Vesicular Breath sounds
Inspiratory sounds last longer than Expiratory sounds in ______
Vesicular Breath sounds
If Bronchial (or Bronchovesicular) sounds are heard over lateral lung regions (where Vesicular sounds should be), this suggests what
normal air-filled lung has been replaced by fluid-filled or solid lung tissue (happens in lobar consolidation pneumonia)
Causes of Crackles (Rales)
Causes include interstitial lung disease, pulmonary edema of congestive heart failure, pneumonia, and sometimes COPD/asthma.
Causes of Rhonchi
pneumonia, COPD exacerbations, Cystic Fibrosis, and bronchitis.
The discovery of rhonchi suggests the presence of _____ and perhaps even bronchioles.
abnormal secretions in bronchi
a high-pitched wheeze that is entirely or predominantly inspiratory
Stridor
Stridor usually indicates partial obstruction of the ____ or ____ and demands immediate attention
trachea; larynx
Causes of Stridor
Epiglottitis, Croup, and foreign body obstruction
T/F - A rub is usually confined to a very localized region of the chest wall
T
Causes of Pleural Rubs (inflammation of the pleura)
Infection, nearby cancer, and some medications.
______ are assessed when you discover abnormally located Bronchial or Bronchovesicular breath sounds.
Transmitted Voice Sounds
