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Clinical Practical Assessment > Respiratory > Flashcards

Respiratory Flashcards

1
Q

positioning of the patient for examination of the anterior chest wall

A

45 degree angle lying on the couch

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2
Q

positioning of the patient for examination of the posterior chest wall

A

ask patient to lean forward and cross arms over their chest

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3
Q

positioning of the patient for examination of the cervical lymph nodes

A

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

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4
Q

exposure of patient in respiratory exam

A

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

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5
Q

how to assess respiratory rate

A

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

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6
Q

respiratory rate is expressed as?

A

breaths/minute

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7
Q

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

A

level of the sternal angle

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8
Q

where does the tracheal position lie?

A

midline of the neck

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9
Q

where is the trachea palpable?

A

from larynx all the way to suprasternal notch

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10
Q

assessment of the position of the trachea in the neck

A

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

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11
Q

causes of tracheal displacement towards the side of the lung lesion

A

upper lobe collapse
upper lobe fibrosis
pneumonectomy

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12
Q

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

A

extensive pleural effusion
tension pneumothorax
chest expansion

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13
Q

how to assess chest expansion on the anterior chest wall

A

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

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14
Q

normal chest expansion on the anterior wall is about?

A

5cm

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15
Q

how to assess chest expansion on the posterior chest wall

A

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

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16
Q

Movement of the anterior chest wall gives some indication of ?

A

expansion of the upper and middle lobes

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17
Q

Movement of the posterior chest wall gives some indication of ?

A

expansion of lower lobes of the lungs

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18
Q

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

A

on the same side

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19
Q

common causes of unilateral decreased expansion

A

pneumothorax
pleural effusion
collapsed lung
consolidation

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20
Q

bilateral decrease in expansion is seen in?

A

asthma

COPD

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21
Q

percussing over the lung produces what sound?

A

hollow, drum-like sound

resonant

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22
Q

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

A

dull

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23
Q

causes of hyper resonant sound on percussion

A

pneumothorax
hollow bowels
COPD

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24
Q

causes of hypo resonant sound on percussion

A

stoney dull pleural effusion

flat/dull lung tumour, consolidation, lung collapse

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25
Q

breath sounds are the result of?

A

air turbulence in the airways

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26
Q

two types of breath sounds?

A

bronchial

vesicular

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27
Q

bronchial sounds are usually heard?

A

over trachea
suprasternal notch
sternal angle
sternoclavicular joints

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28
Q

what results in the low pitch vesicular sound?

A

lung tissues filters the sound

29
Q

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

A

above the clavicle where the apices are

30
Q

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

A

everywhere apart from the apices

31
Q

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

A

take the deep breaths in and out through the mouth

32
Q

what are the characteristics of vesicular breath sounds?

A

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

33
Q

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

A 
shallow breathing
airway obstruction
hyperinflation
pneumothorax
pleural effusion
pleural thickening
obesity
34
Q

in what diseases does expiration become prolonged?

A

obstructive lung disease like asthma and chronic bronchitis

35
Q

what are the characteristics of bronchial breath sounds?

A

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.

36
Q

what is tactile vocal fremitus?

A

vibration of the chest wall during vocal sounds

37
Q

how to examine tactile vocal fremitus

A

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

38
Q

An decrease in the tactile vocal fremitus is caused by?

A

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

39
Q

An increase in the tactile vocal fremitus is caused by?

A

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

40
Q

how to examine cervical lymph nodes?

A

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

41
Q

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

A

don’t lift hands off the patient

42
Q

list cervical lymph nodes

A 
submental
submandibular
preauricular/parotid
postauricular
occipital
superior deep cervical
inferior deep cervical
supraclavicular
43
Q

Respiratory causes of cervical lymph node lymphadenopathy

A

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

44
Q

boundaries of the anterior triangle of the neck

A

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

45
Q

content of the anterior triangle of the neck

A

CN VII, IX, X, XI, XII

common carotid

46
Q

boundaries of the posterior triangle of the neck

A

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

47
Q

contents of the posterior triangle of the neck

A

external jugular vein
subclavian vein
CN XI

48
Q

list palpable anatomical landmarks of the thoracic skeleton on the chest

A 
jugular notch
sternal angles
sternoclavicular joint
costal margin
ribs
49
Q

boundaries of the superior thoracic aperture

A

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

50
Q

what important structures pass through the superior thoracic aperture?

A 
common carotids
subclavian arteries and veins
jugular vein
trachea
oesophagus
51
Q

boundaries of the inferior thoracic aperture

A

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

52
Q

what important structures pass through the inferior thoracic aperture?

A

aorta
oesophagus
inferior vena cava

53
Q

list intercostal muscles from superficial to deep

A

external intercostals
internal intercostal
innermost intercostal

54
Q

which direction do the external intercostal muscle fibres run?

A

obliquely
downward
forward

55
Q

which direction do the internal intercostal muscle fibres run?

A

obliquely
downward
backward
(at 90 degrees to external)

56
Q

the neurovascular bundle is made up of?

A

vein
artery
nerve

57
Q

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

A

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

58
Q

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

A

above

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

59
Q

identify the accessory muscles of respiration

A 
sternocleidomastoid
scalenes group (anterior, medius, posterior)
pectoralis minor
60
Q

function of accessory muscles for assisting respiration

A

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

61
Q

how does the diaphragm move on inspiration?

A

contracts
flattens
increases chest volume

62
Q

how does the diaphragm move on expiration?

A

relaxes
domes
decreases chest volume

63
Q

what important structures pass through the diaphragm?

A

oesophagus
aorta
vena cava

64
Q

the oesophagus passes through the diaphragm at what vertebral level?

A

T10

65
Q

the aorta passes through the diaphragm at what vertebral level?

A

T12

66
Q

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

A

T8

67
Q

list lobes and fissures of the right lung

A

superior, middle, inferior

horizontal and oblique

68
Q

list lobes and fissures of the left lung

A

superior
inferior
oblique

69
Q

list paranasal air sinuses

A

maxillary
frontal
ethmoid air cells
sphenoid

Clinical Practical Assessment (7 decks)

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