Respiratory

Question 1

positioning of the patient for examination of the anterior chest wall

Answer 1

45 degree angle lying on the couch

Question 2

positioning of the patient for examination of the posterior chest wall

Answer 2

ask patient to lean forward and cross arms over their chest

Question 3

positioning of the patient for examination of the cervical lymph nodes

Answer 3

sit across the couch with legs hanging off the edge of the bed

Question 4

exposure of patient in respiratory exam

Answer 4

exposed from the waist upwards, offer the patient a blanket so they will only be exposed when appropriate, and if relevant patients do not need to remove their bras

Question 5

how to assess respiratory rate

Answer 5

visually observing the anterior chest wall (and abdominal walls) movements for 30 seconds while the subject breaths quietly WITHOUT PATIENT BEING AWARE

Question 6

respiratory rate is expressed as?

Answer 6

breaths/minute

Question 7

where does the trachea divide into left and right main bronchi?

Answer 7

level of the sternal angle

Question 8

where does the tracheal position lie?

Answer 8

midline of the neck

Question 9

where is the trachea palpable?

Answer 9

from larynx all the way to suprasternal notch

Question 10

assessment of the position of the trachea in the neck

Answer 10

place the forefinger of your right hand at the suprasternal notch of the patient and push it upwards and backwards until the trachea is felt

Question 11

causes of tracheal displacement towards the side of the lung lesion

Answer 11

upper lobe collapse
upper lobe fibrosis
pneumonectomy

Question 12

causes of tracheal displacement away from the side of the lung lesion

Answer 12

extensive pleural effusion
tension pneumothorax
chest expansion

Question 13

how to assess chest expansion on the anterior chest wall

Answer 13

hands on the anterior chest wall (just below 5/6th ribs) with fingers extended around the sides of the chest, thumbs should meet in anterior midline, patient takes a deep breath and observe the tips of your thumbs move apart

Question 14

normal chest expansion on the anterior wall is about?

Answer 14

5cm

Question 15

how to assess chest expansion on the posterior chest wall

Answer 15

same as anterior at posterior midline at the level of the 10th thoracic vertebra look for any asymmetry

Question 16

Movement of the anterior chest wall gives some indication of ?

Answer 16

expansion of the upper and middle lobes

Question 17

Movement of the posterior chest wall gives some indication of ?

Answer 17

expansion of lower lobes of the lungs

Question 18

does reduced expansion of the chest wall on one side suggest lesion on that side or the opposite side?

Answer 18

on the same side

Question 19

common causes of unilateral decreased expansion

Answer 19

pneumothorax
pleural effusion
collapsed lung
consolidation

Question 20

bilateral decrease in expansion is seen in?

Answer 20

asthma

COPD

Question 21

percussing over the lung produces what sound?

Answer 21

hollow, drum-like sound

resonant

Question 22

percussing over organs like the heart or over fluid produces what sound?

Answer 22

dull

Question 23

causes of hyper resonant sound on percussion

Answer 23

pneumothorax
hollow bowels
COPD

Question 24

causes of hypo resonant sound on percussion

Answer 24

stoney dull pleural effusion

flat/dull lung tumour, consolidation, lung collapse

Question 25

breath sounds are the result of?

Answer 25

air turbulence in the airways

Question 26

two types of breath sounds?

Answer 26

bronchial | vesicular

Question 27

bronchial sounds are usually heard?

Answer 27

over trachea suprasternal notch sternal angle sternoclavicular joints

Question 28

what results in the low pitch vesicular sound?

Answer 28

lung tissues filters the sound

Question 29

when do you use the bell of the stethoscope to listen to the breath sounds?

Answer 29

above the clavicle where the apices are

Question 30

when do you use the diaphragm of the stethoscope to listen to the breath sounds?

Answer 30

everywhere apart from the apices

Question 31

if the breath sounds are inaudible, ask the patient to?

Answer 31

take the deep breaths in and out through the mouth

Question 32

what are the characteristics of vesicular breath sounds?

Answer 32

soft, low pitched, rustling inspiratory phase longer than expiratory intensity of inspiratory phase is greater than that of expiration inspiration is a higher pitch than expiration no pause between inspiration and expiration

Question 33

main causes of reduction in intensity of vesicular breath sound are?

Answer 33

``` shallow breathing airway obstruction hyperinflation pneumothorax pleural effusion pleural thickening obesity ```

Question 34

in what diseases does expiration become prolonged?

Answer 34

obstructive lung disease like asthma and chronic bronchitis

Question 35

what are the characteristics of bronchial breath sounds?

Answer 35

loud, hollow, and high pitch expiratory phase is longer than the inspiratory distinct pause between inspiration and expiration normally heard over the manubrium and interscapular area. also heard over consolidation, localised pulmonary fibrosis, pleural effusion and collapsed lung.

Question 36

what is tactile vocal fremitus?

Answer 36

vibration of the chest wall during vocal sounds

Question 37

how to examine tactile vocal fremitus

Answer 37

Ask the patient to say "ninety nine" Palpate across the chest wall with your hands You should feel the vibrations equally in both hand

Question 38

An decrease in the tactile vocal fremitus is caused by?

Answer 38

decrease in density like pneumothorax, COPD | also be caused by an increase in the distance between the chest wall and the lungs like pleural effusion

Question 39

An increase in the tactile vocal fremitus is caused by?

Answer 39

increase in density, such as consolidation in pneumonia, or tumour tissue in cancer

Question 40

how to examine cervical lymph nodes?

Answer 40

Position the patient sitting and examine from behind You will use both hands to examine the lymph nodes on each side simultaneously Using the pads of the fingers in a circular motion palpate across all the cervical lymph node groups

Question 41

how to make sure you don't miss any cervical lymph nodes

Answer 41

don't lift hands off the patient

Question 42

list cervical lymph nodes

Answer 42

``` submental submandibular preauricular/parotid postauricular occipital superior deep cervical inferior deep cervical supraclavicular ```

Question 43

Respiratory causes of cervical lymph node lymphadenopathy

Answer 43

Lung cancer metastasising to the lymph nodes Tuberculosis Sarcoidosis Respiratory tract infection

Question 44

boundaries of the anterior triangle of the neck

Answer 44

midline of the neck anterior border of the sternocleidomastoid muscle inferior border of the mandible

Question 45

content of the anterior triangle of the neck

Answer 45

CN VII, IX, X, XI, XII | common carotid

Question 46

boundaries of the posterior triangle of the neck

Answer 46

middle 1/3 of the clavicle posterior border of the sternocleidomastoid muscle anterior border of the trapezius

Question 47

contents of the posterior triangle of the neck

Answer 47

external jugular vein subclavian vein CN XI

Question 48

list palpable anatomical landmarks of the thoracic skeleton on the chest

Answer 48

``` jugular notch sternal angles sternoclavicular joint costal margin ribs ```

Question 49

boundaries of the superior thoracic aperture

Answer 49

T1 first ribs (left and right) superior aspect of the sternum

Question 50

what important structures pass through the superior thoracic aperture?

Answer 50

``` common carotids subclavian arteries and veins jugular vein trachea oesophagus ```

Question 51

boundaries of the inferior thoracic aperture

Answer 51

T12 11th/12th ribs cartilages of 10-7 ribs to form costal angle

Question 52

what important structures pass through the inferior thoracic aperture?

Answer 52

aorta oesophagus inferior vena cava

Question 53

list intercostal muscles from superficial to deep

Answer 53

external intercostals internal intercostal innermost intercostal

Question 54

which direction do the external intercostal muscle fibres run?

Answer 54

obliquely downward forward

Question 55

which direction do the internal intercostal muscle fibres run?

Answer 55

obliquely downward backward (at 90 degrees to external)

Question 56

the neurovascular bundle is made up of?

Answer 56

vein artery nerve

Question 57

what are the boundaries for a safe location for a chest drain?

Answer 57

lateral edge of pectoralis major level of 5th intercostal space (around the nipple) base of the axilla lateral edge of latissimus dorsi

Question 58

should you insert a chest drain above or below a rib? why?

Answer 58

above | avoid damaging the neurovascular bundle which sits just under the rib in the costal groove

Question 59

identify the accessory muscles of respiration

Answer 59

``` sternocleidomastoid scalenes group (anterior, medius, posterior) pectoralis minor ```

Question 60

function of accessory muscles for assisting respiration

Answer 60

sternocleidomastoid > elevates sternum scalenes group > elevate upper ribs pectoralis minor > elevates ribs for deep inspiration

Question 61

how does the diaphragm move on inspiration?

Answer 61

contracts flattens increases chest volume

Question 62

how does the diaphragm move on expiration?

Answer 62

relaxes domes decreases chest volume

Question 63

what important structures pass through the diaphragm?

Answer 63

oesophagus aorta vena cava

Question 64

the oesophagus passes through the diaphragm at what vertebral level?

Answer 64

T10

Question 65

the aorta passes through the diaphragm at what vertebral level?

Answer 65

T12

Question 66

the vena cava passes through the diaphragm at what vertebral level?

Answer 66

T8

Question 67

list lobes and fissures of the right lung

Answer 67

superior, middle, inferior | horizontal and oblique

Question 68

list lobes and fissures of the left lung

Answer 68

superior inferior oblique

Question 69

list paranasal air sinuses

Answer 69

maxillary frontal ethmoid air cells sphenoid