Respiratory

Question 1

Tracheal/bronchial breath sounds

Where is it heard? What pitch? I or E greater?

Answer 1

heard over trachea; high pitch; loud with long expiration E>I

Question 2

Vesicular breath sounds. Where are they heard. What pitch? I or E?

Answer 2

heard over most lung fields; low pitch; soft and short expirations I>E

Question 3

Bronchovesicular. Where are they heard? What pitch? I or E?

Answer 3

heard over main bronchus (1 and 2nd intercostal spaces) area and b/w scapula; medium pitch E=I

Question 4

Crackles or RHALES - what do they sound like and with what conditions? Hear them on I or E? What causes the sounds

Answer 4

• Fine, coarse, inspiratory, expiratory
• Airway secretions - occurs d/t fluid in the lungs
• Bronchitis, infection, pulmonary edema, atelectasis, CHF, pneumonia
• Sounds like clicking and rattling/velcro

Question 5

Wheezing - what does it sound like? what causes it? In what conditions? Most common?

Answer 5

Sounds like high-pitched whistling

• airflow obstruction causes it
• Asthma, pulmonary edema, bronchitis, CHF
• Most common causes are COPD and asthma

Question 6

Rhonchi - what could cause this to change? Sounds like? Caused by? What conditions?

Answer 6

coughing

• sounds like snoring, gurgling, or rumbling. Snoring quality. Low-pitch
• kind of sounds like a low-pitch wheezing
• often caused by copious secretions in the airway – thick secretions cause turbulent air flow through large airways or bronchi
• COPD, CF, bronchiectasis, pneumonia

Question 7

Pleural friction rub. Found in what conditions?

Answer 7

• Pleural inflammation
• Pleural rubs are discontinuous or continuous, creaking or grating sounds. The sound has been described as similar to walking on fresh snow or a leather-on-leather type of sound. Coughing will not alter the sound. They are produced because two inflamed surfaces are sliding by one another, such as in pleurisy.
• Pneumonia, pulmonary infarction

Question 8

Decreased tactile fremitus with?

Answer 8

COPD, thick chest wall, obstructed bronchus, pleural effusion, fibrosis, air (pneumothorax), or an infiltrating tumor

Question 9

Flatness percussion note: pitch? soft or loud? which area of the body

Answer 9

Thigh
High pitch
Soft

Question 10

Dullness percussion: pitch? soft or loud? which area of the body

Answer 10

Organs/liver
Medium
Medium pitch

Question 11

Resonance: pitch? soft or loud? which area of the body?

Answer 11

Healthy lung tissue
LOW pitch
Loud

Question 12

Hyperresonance: pitch? soft or loud? Which area of body?

Answer 12

• Usually none for area of body, but she said puffed cheek
• Lower pitch than resonant
• Loud

Question 13

Tympany: pitch? soft or loud? which area of body?

Answer 13

gastric
high pitch
loud

Question 14

Stridor - frequency? pitch? causes?

Answer 14

continuous, high-frequency, high pitch musical sound produced during airflow through a narrowing in the UPPER respiratory tract

• stridor is best heard over the neck during inspiration but can be biphasic
• tracheal stenosis from intubation, airway edema after device removal, epiglottitis, foreign body, and anaphylaxis
• immediate intervention necessary

Question 15

Reasons why lungs might be hyperresonant on percussion

Answer 15

pneumothroax, emphysema

Question 16

Reasons why lungs might be dull on percussion

Answer 16

pulmonary edema, hemothorax, probably pneumonia

Question 17

Middle lobe of right lung best auscultated?

Answer 17

in right axillary region