Respiratory Exam Flashcards
At what level does the trachea bifurcate?
¡Trachea bifurcates at the carina at levels of sternal angle anteriorly and T4 spinous process posteriorly
What is the anterior lower border of the lungs?
Crosses the 6th rib at midclavicular line & the 8th rib at mid axillary line
What is the posterior lower border?
lLies about level of T10 spinous process
___________:
Divides lung roughly in half
T3 spinous process obliquely down & around chest to 6th rib at midclavicular line
Oblique fissure
______________________:
Right lung divided into minor fissure
Runs close to 4th rib & meets oblique fissure in midaxillary line near 5th rib
Horizontal Fissure
Two types of pleurae?
Visceral
Parietal
What are the common examination positions for the patient?
Sitting
Supine
Unable to sit up without aid
¡Inspect neck during inspiration, what are you looking for?
lIs there use of accessory muscles or supraclavicular retractions?l Is the trachea midline?
In a normal chest what diameter is larger?
Lateral diameter should be larger than AP
Identify these conditions
Pectus excavatum (funnel chest)
Barrel Chest (barrel chest)
Pectus carinatum (Pidgeon Chest)
What should we note upon posterior observation of the chest?
¡Deformities/asymmetry¡Abnormal retractions of interspaces in inspiration¡Impaired resp. movement on one or both sides or unilateral lag in movement
How do you palpate for respiratory expansion?
Thumbs at level 10th ribs with fingers loosely grasping & parallel to lateral rib cage
Ask pt. to inhale deeply watch and feel for symmetry
What is Fremitus?
lPalpable vibrations transmitted through bronchopulmonary tree to chest wall when pt. speaks (normal to feel on someone w/ clear lungs)
How do you palpate for fremitus?
lUse thenar/hypothenar eminences to optimize vibratory sensitivity
Ask pt. to repeat “99” or “one-one-one”
Describe the posts to palpate for fremitus
Where is fremitus more prominent? Where is it usually decreased or absent?>
oPosterior exam
•Typically more prominent in interscapular area & right sided than lower lung fields
oAnterior exam
Usually dec. or absent over cardiac area
What abnormalities might be indicated by increased fremitus?
¡Inc. as vibration from larynx to chest in enhanced as when consolidation is present (ie. pneumonia)
What would cause decreased fremitus?
¡Dec. or absent when vibration from larynx to chest surface impeded (ie. COPD, obstruction, pleural effusion or pneumothorax)
What is the procedure for percussion? (how do you do it?)
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
Fill in the location boxes.
In percussion…
Dullness replaces resonance when?
fluid or solid tissue replaces air-containing lung
How does one…
Identify level of diaphragmatic excursion
Distance between level of dullness on full expiration and full inspiration
Normal 5-6 cm
If diaphragmatic excursion is abnormally high then it suggests…
pleural effusion or high diaphragm
lHeart produces area dullness to left of sternum from ____ to _____ ICS
3rd-5th
lt is Harder to detect effusions anteriorly because?
pleural fluid sinks to lowest part of pleura space
lDullness of RML pneumonia typically occurs behind?
right breast unless you displace breast you may miss it
Fill in the location normally heard blanks.
Where are the listening posts for auscultation?
In what situations while breath sounds be decreased?
When airflow is decreased
Obstructive lung disease or muscle weakness
When transmission of sound is poor
Pleural effusion, pneumothorax, emphysema
___________:
Wheeze-relatively high pitched (>400 Hz) with hissing or shrill quality
Sibilant rhonchi
_______________:
Rhonchi- relatively low pitched (<200/Hz) with snoring quality
Sonorous rhonchi
What does Wheeze/rhonchi suggest?
Suggests partial airway obstruction-secretions, inflammation or foreign body
What is stridor? Where is it loudest? What does it indicate?
Wheeze that is predominately or entirely in inspiration
Louder in neck than chest wall
Indicates partial obstruction of larynx or trachea
________________:
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
Crackles/Rales
What does pleural rub sound like? Where is it normally heard? When is it heard?
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
Fill in the blanks for the abnormal sounds
Good luck on the final!
