Respiratory Exam

Question 1

At what level does the trachea bifurcate?

Answer 1

¡Trachea bifurcates at the carina at levels of sternal angle anteriorly and T4 spinous process posteriorly

Question 2

What is the anterior lower border of the lungs?

Answer 2

Crosses the 6th rib at midclavicular line & the 8th rib at mid axillary line

Question 3

What is the posterior lower border?

Answer 3

lLies about level of T10 spinous process

Question 4

___________:

Divides lung roughly in half
T3 spinous process obliquely down & around chest to 6th rib at midclavicular line

Answer 4

Oblique fissure

Question 5

______________________:

Right lung divided into minor fissure
Runs close to 4th rib & meets oblique fissure in midaxillary line near 5th rib

Answer 5

Horizontal Fissure

Question 6

Two types of pleurae?

Answer 6

Visceral

Parietal

Question 7

What are the common examination positions for the patient?

Answer 7

Sitting

Supine

Unable to sit up without aid

Question 8

¡Inspect neck during inspiration, what are you looking for?

Answer 8

lIs there use of accessory muscles or supraclavicular retractions?l Is the trachea midline?

Question 9

In a normal chest what diameter is larger?

Answer 9

Lateral diameter should be larger than AP

Question 10

Identify these conditions

Answer 10

Pectus excavatum (funnel chest)

Barrel Chest (barrel chest)

Pectus carinatum (Pidgeon Chest)

Question 11

What should we note upon posterior observation of the chest?

Answer 11

¡Deformities/asymmetry¡Abnormal retractions of interspaces in inspiration¡Impaired resp. movement on one or both sides or unilateral lag in movement

Question 12

How do you palpate for respiratory expansion?

Answer 12

Thumbs at level 10th ribs with fingers loosely grasping & parallel to lateral rib cage

Ask pt. to inhale deeply watch and feel for symmetry

Question 13

What is Fremitus?

Answer 13

lPalpable vibrations transmitted through bronchopulmonary tree to chest wall when pt. speaks (normal to feel on someone w/ clear lungs)

Question 14

How do you palpate for fremitus?

Answer 14

lUse thenar/hypothenar eminences to optimize vibratory sensitivity

Ask pt. to repeat “99” or “one-one-one”

Question 15

Describe the posts to palpate for fremitus

Answer 15

Question 16

Where is fremitus more prominent? Where is it usually decreased or absent?>

Answer 16

oPosterior exam
•Typically more prominent in interscapular area & right sided than lower lung fields

oAnterior exam
Usually dec. or absent over cardiac area

Question 17

What abnormalities might be indicated by increased fremitus?

Answer 17

¡Inc. as vibration from larynx to chest in enhanced as when consolidation is present (ie. pneumonia)

Question 18

What would cause decreased fremitus?

Answer 18

¡Dec. or absent when vibration from larynx to chest surface impeded (ie. COPD, obstruction, pleural effusion or pneumothorax)

Question 19

What is the procedure for percussion? (how do you do it?)

Answer 19

lHyperextend middle finger pressing the distal interphalangeal joint firmly on the surface

Keep all other fingers off chestlPosition opposite hand forearm close to surface with hand cocked upward

Middle finger partially flexed, relaxed, and poised to strike

With quick, sharp but relaxed wrist motion aim you middle finger at your distal interphalangeal joint that is on chest

Strike using tip of middle finger (not pad)

Withdraw finger quickly as not to dampen the vibration you have created

Question 20

Fill in the location boxes.

Answer 20

Question 21

In percussion…
Dullness replaces resonance when?

Answer 21

fluid or solid tissue replaces air-containing lung

Question 22

How does one…

Identify level of diaphragmatic excursion

Answer 22

Distance between level of dullness on full expiration and full inspiration
Normal 5-6 cm

Question 23

If diaphragmatic excursion is abnormally high then it suggests…

Answer 23

pleural effusion or high diaphragm

Question 24

lHeart produces area dullness to left of sternum from ____ to _____ ICS

Answer 24

3rd-5th

Question 25

lt is Harder to detect effusions anteriorly because?

Answer 25

pleural fluid sinks to lowest part of pleura space

Question 26

lDullness of RML pneumonia typically occurs behind?

Answer 26

right breast unless you displace breast you may miss it

Question 27

Fill in the location normally heard blanks.

Answer 27

Question 28

Where are the listening posts for auscultation?

Answer 28

Question 29

In what situations while breath sounds be decreased?

Answer 29

When airflow is decreased
Obstructive lung disease or muscle weakness

When transmission of sound is poor
Pleural effusion, pneumothorax, emphysema

Question 30

___________:

Wheeze-relatively high pitched (>400 Hz) with hissing or shrill quality

Answer 30

Sibilant rhonchi

Question 31

_______________:

Rhonchi- relatively low pitched (<200/Hz) with snoring quality

Answer 31

Sonorous rhonchi

Question 32

What does Wheeze/rhonchi suggest?

Answer 32

Suggests partial airway obstruction-secretions, inflammation or foreign body

Question 33

What is stridor? Where is it loudest? What does it indicate?

Answer 33

Wheeze that is predominately or entirely in inspiration
Louder in neck than chest wall
Indicates partial obstruction of larynx or trachea

Question 34

________________:

Discontinuous
Intermittent, nonmusical, & brief
Fine crackles-soft, high pitched, very brief (5-10msec)
Coarse crackles-somewhat louder, lower pitched, brief (20-30 msec)

Inspiration—early vs. late

Answer 34

Crackles/Rales

Question 35

What does pleural rub sound like? Where is it normally heard? When is it heard?

Answer 35

Resemble crackles by sound
Often discrete but if numerous can seem continuous
Typically confined to small area of chest wall
Heard in both phases of respiration

Question 36

Fill in the blanks for the abnormal sounds

Answer 36

Question 37

Good luck on the final!

Answer 37