Pulmonary Exam

Question 1

You count the ribs by looking first for the _____

Answer 1

Sternal angle

Question 2

Having a ____ approach to the exam will help you to perform all aspects of the exam without skipping portions.

Answer 2

systematic

Question 3

In an initial survey, observe the patient’s _____ of breathing

Answer 3

respiratory rate, rhythm, depth, and effort

Question 4

From a midline position in front of or behind the patient, note the ____ of the chest and how the chest moves.

Answer 4

shape

Question 5

Clubbing Can be indicative of a _____

Answer 5

chronic lung disease

Question 6

Inspect the neck for any signs of _____

Answer 6

accessory muscle contraction.
- Sternomastoid
- Scalenes

Question 7

The A-P diameter can increase with ____, or may be a sign of ______

Answer 7

aging; chronic obstructive lung disease.

Question 8

Acute tenderness to palpation over pectoral muscles or at the costal cartilage support, but do not prove, that the chest pain has a _____

Answer 8

musculoskeletal origin

Question 9

When testing chest expansion, place your thumbs at approximately the level of the _____ rib posteriorly (or at inferior sternum anteriorly).

Answer 9

10th

Question 10

Several pathologic conditions can cause unilateral decreased chest expansion, or a delay in chest expansion, including:

Answer 10

Chronic Pulmonary Fibrosis
Pleural effusion
Significant lobar pneumonia
Pneumothorax
Unilateral bronchial obstruction

Question 11

Fremitus refers to the _____ transmitted through the bronchopulmonary tree to the chest wall as the patient speaks.

Answer 11

palpable vibrations

Question 12

Conditions that make the lung more solid so vibrations are transmitted more easily (Increased fremitus)

Answer 12

Pneumonia
Pulmonary edema (within alveoli)
Heavy bronchial secretions
Solid mass within the lung

Question 13

Conditions that make the lung less solid or pull the lung away from the thoracic wall. (Decreased fremitus)

Answer 13

Overexpansion (like emphysema)
Pneumothorax
Pleural effusion
Increased body fat

Question 14

_____ helps you establish whether underlying tissues are air-filled, fluid-filled, or solid.

Answer 14

Percussion

Question 15

An abnormally high level of dullness on one side when completing a diaphragmatic excursion test might suggest

Answer 15

A large pleural effusion

Question 16

Auscultation involves

Answer 16

1. Listening to sounds generated by breathing
2. Listening for adventitious sounds
3. If abnormalities are suspected, listening to patient’s spoken or whispered voice

Question 17

Adventitious (Added) Sounds are abnormal sounds superimposed on the usual breath sounds and include

Answer 17

Wheezing
Crackles (Rales)
Rhonchi
(Stridor and Pleural friction rubs also abnormal)

Question 18

T/F - Inspiratory and Expiratory sounds are about equal in pitch, intensity, and duration in Tracheal Breath sounds.

Answer 18

T

Question 19

Bronchial breath sounds are best heard where?

Answer 19

over the manubrium and in the first and second interspaces.

Question 20

Where do Expiratory sounds last slightly longer than the Inspiratory sounds?

Answer 20

Bronchial Breath sounds

Question 21

The pitch of _______ is relatively low compared to tracheal and bronchial sounds.

Answer 21

Vesicular Breath sounds

Question 22

Inspiratory sounds last longer than Expiratory sounds in ______

Answer 22

Vesicular Breath sounds

Question 23

If Bronchial (or Bronchovesicular) sounds are heard over lateral lung regions (where Vesicular sounds should be), this suggests what

Answer 23

normal air-filled lung has been replaced by fluid-filled or solid lung tissue (happens in lobar consolidation pneumonia)

Question 24

Causes of Crackles (Rales)

Answer 24

Causes include interstitial lung disease, pulmonary edema of congestive heart failure, pneumonia, and sometimes COPD/asthma.

Question 25

Causes of Rhonchi

Answer 25

pneumonia, COPD exacerbations, Cystic Fibrosis, and bronchitis.

Question 26

The discovery of rhonchi suggests the presence of _____ and perhaps even bronchioles.

Answer 26

abnormal secretions in bronchi

Question 27

a high-pitched wheeze that is entirely or predominantly inspiratory

Answer 27

Stridor

Question 28

Stridor usually indicates partial obstruction of the ____ or ____ and demands immediate attention

Answer 28

trachea; larynx

Question 29

Causes of Stridor

Answer 29

Epiglottitis, Croup, and foreign body obstruction

Question 30

T/F - A rub is usually confined to a very localized region of the chest wall

Answer 30

T

Question 31

Causes of Pleural Rubs (inflammation of the pleura)

Answer 31

Infection, nearby cancer, and some medications.

Question 32

______ are assessed when you discover abnormally located Bronchial or Bronchovesicular breath sounds.

Answer 32

Transmitted Voice Sounds