Respiratory

Question 1

What are common labs and diagnostics to assess any respiratory complaints?

Answer 1

• ABG
• PFT (Peak flow test or spirometer)
• CT scan
• CXR
• sputum cultures
• sleep studies
• Flu, RSV, Covid
• Bronchoscopy, biopsy

Question 2

During inspiration what do does the diaphragm, thorax, and lungs do?

Answer 2

Diaphragm contracts

Thorax and lungs expand

Question 3

During expiration what does the diaphragm, thorax, and lungs and do?

Answer 3

Diaphragm relaxes and rises passively

The chest wall and lungs recoil

Question 4

During the general survey what are 3 things that we are noting?

Answer 4

Mental state, skin color, and oxygenation status (finger/toenails, lips, tripoding, accessory msl use)

Question 5

What is pectus excavatum?

Answer 5

Dip in chest cavity

Question 6

What is pectus carinatum?

Answer 6

Pigeon chest

Question 7

What is the tactile fremitus test?

Answer 7

Feeling vibrations transmitted through lung tissues and the chest wall when vocal sound is made

Question 8

What does it mean if fremitus decreases?

Answer 8

The issue is outside of the lung. There is something obstructing transmission of air/vibrations to the viscera.

Pleural effusion, pneumothorax, obstructed bronchus.

Question 9

What does it mean if fremitus increases?

*hint: over an area of liquid the vibrations will intensify

Answer 9

The issue is inside the lung. It occurs with consolidation or compression of lung tissue.

PNA, tumor, atelectasis

Question 10

What is the purpose of the percussion test?

Answer 10

To produce audible sounds and palpate vibrations. It demonstrates the quality of air space below the chest wall.

Question 11

What does resonance mean on percussion?

Answer 11

Air inside a normal lung

Question 12

What does hyperresonance mean on percussion? With example

Answer 12

Lung can be hyperinflation. COPD and pneumothorax

Question 13

What is dullness on percussion?

Answer 13

Over dense tissue

Question 14

What are 3 types of normal breath sounds?

Answer 14

1. Bronchial/tracheal (loud sounds over the mandubrium and trachea)
2. Bronchovesicular (intermediate sounds over 1st and 2nd intercostal spaces anteriorly and between the scapulae)
3. Vesicular (soft sound over lungs)

Question 15

What are 3 things we listening for on auscultation?

Answer 15

Duration, intensity, and pitch.

Question 16

5 adventitious breath sounds we may hear on auscultation?

Answer 16

Crackles (rales) , wheezes, Ronchi, stridor, and pleural friction rub.

Question 17

What 6 things do we assess for in a hospitalized patient?

Answer 17

1. Natural vs artificial airway
2. ability to cough
3. Work of breath
4. Shape of chest
5. SpO2 and O2 delivery
6. Auscultate lung sounds

Question 18

Respiratory diseases that can cause wheezing?

Answer 18

Reactive airway disease, asthma

Question 19

What respiratory diseases can be considered with crackles?

Answer 19

PNA, fibrosis, early CHF

Question 20

Where is the angle of Louis AKA the sternal angle?

Answer 20

Junction between manubrium and sterna body, near 2nd rib

Question 21

Where are the lung apices on the anterior chest located?

Answer 21

3-4cm above clavicles

Question 22

What should we assess for in a hospitalized patient? (6)

Answer 22

Natural vs artificial airway, ability to cough, work of breath, shape of chest, spo2 and oxygen delivery system, auscultate lung sounds.