Respiratory/Thorax/Lungs

Question 1

ABC of cardiac/pulmonary

Answer 1

airway, breathing, circulation

Question 2

anterior thoracic landmarks

Answer 2

suprasternal notch, sternum, costal angle

Question 3

posterior thoracic landmarks

Answer 3

spinous processes
inferior border of scapula
twelfth rib

Question 4

upper lobes posterior landmarks

Answer 4

between c7 and t3

Question 5

right lung is [shorter/narrower] and left lung is [shorter/narrower]

Answer 5

left lung is longer and narrower (2 lobes) - heart

right lung is shorter and wider (3 lobes) - liver

Question 6

upper lobes are best heard on [posterior/anterior] chest

Answer 6

anterior

Question 7

right middle lobe is best heard

Answer 7

anterior into mid axillary line – can’t hear posterior

Question 8

lower lobes are best heard [anterior/posterior]

Answer 8

posterior

Question 9

which lung has a middle lobe

Answer 9

right

Question 10

respiratory hx

dx of concern

Answer 10

COPD, asthma, chronic bronchitis, lung cancer

Question 11

respiratory hx

sx of concern

Answer 11

cough, dyspnea, chest pain with breathing

Question 12

behavioral/lifestyle factors

Answer 12

• smoking history (incl vaping), medications, self-care behaviors
• environmental exposure, occupational exposure

Question 13

sequence these:

• percussion
• auscultation
• inspection
• palpation

Answer 13

• inspection
• palpation
• percussion (used occasionally)
• auscultation

Complete whole sequence on front or back, then repeat. Order isn’t as important here as it is in GI.

Question 14

t/f: auscultation is fine over the clothing

Answer 14

false, should be performed directly on the skin

Question 15

inspection elements

Answer 15

• ease/effort
• dyspnea, orthopnea
• chest movement and accessory muscle
• sputum
• skin color (natural light)

Question 16

Qualities of breathing

Answer 16

• rate (tachypnea, bradypnea, apnea)
• volume (hyper/hypoventilation)
• depth (deep, normal, shallow)
• rhythm (regular, pauses)
• ease (labored, unlabored)

Question 17

breathing pattern with pneumonia, pulmonary edema, acidosis, septicemia, pain

Answer 17

tachypnea

Question 18

breathing pattern with ICP, drug OD, alkalosis, benzos/alcohol

Answer 18

bradypnea

Question 19

hyperventilation vs. tachypnea

Answer 19

tachypnea is shallow. hyperventilation increases depth and rate >22

Question 20

hypoventilation vs bradypnea

Answer 20

bradypnea not always shallow. hypoventilation is depth and rate decreased <10.

Question 21

not breathing

Answer 21

apnea

Question 22

breathing pattern

with variable rate and depth. Regular-irregular rhythm cycles slow and shallow to deep and fast. Period of apnea. (crescendo and decrescendo)

Answer 22

Cheyne-Stokes: mostly dying – can be accompanied by death rattles/rales. But also TBI, altitude sickness, heart failure.

Question 23

breathing pattern

rate and depth can be variable. Irregular. Increased rate and depth with abrupt pauses.

Answer 23

Biot’s: head injury, trauma, stroke in medulla oblongata, prolonged opioid use

Question 24

breathing pattern

Regular but abnormally deep and increased in rate. Labored and using accessory muscles.

Answer 24

Kussmaul: DKA, exercise, metabolic acidosis, renal failure.

this is a type of hyperventilation

Question 25

markers of respiratory effort

Answer 25

labored/unlabored, retractions, nares flaring, pursed lip breathing

Question 26

kyphosis

Answer 26

abnormal anterior spine curvature

Question 27

scoliosis

Answer 27

abnormal lateral spine curvature

Question 28

spinal damage above this landmark can cause failure of spontaneous respiration

Answer 28

c5

Question 29

palpation assessment points

Answer 29

- tenderness - temperature - skin integrity - position of trachea - symmetrical expansion

Question 30

# normal breath sounds sounds near the sternum and between the scapulae - moderate pitch and intensity - occur equally over inspiration and expiration

Answer 30

broncho-vesicular sounds

Question 31

# normal breath sounds hear around the trachea, high pitched and harsh with a long, loud expiration

Answer 31

bronchial sounds

Question 32

# normal breath sounds vesicular sounds

Answer 32

audible over anterior, soft breezy quality during inspiration

Question 33

# adventitious breath sounds crackling or popping sounds of varying intensity, not caused by cough

Answer 33

crackles

Question 34

# adventitious breath sounds low, coarse, gurgling, louder sounds. may be altered or cleared by coughing. may have a moaning or snoring quality. heard at end of inhale and beginning of exhale.

Answer 34

rhonchi (gurgles)

Question 35

# adventitious breath sounds breath sound caused by air passing through fluid or mucus

Answer 35

crackles

Question 36

# adventitious breath sounds breath sound caused by air passing through narrowed air passages due to secretions, swelling, or tumors

Answer 36

rhonchi (gurgles)

Question 37

whistling sound, could be musical, moaning, sonorous

Answer 37

wheeze

Question 38

squeaking or grating heard in lateral lung fields during inspiration and expiration

Answer 38

pleural friction rub

Question 39

caused by air passing through a constricted bronchus due to asthma, secretions, swelling, or tumors

Answer 39

wheeze

Question 40

caused by the rubbing together of inflamed pleural surfaces

Answer 40

pleural friction rub

Question 41

crowing noise heard during inspiration

Answer 41

stridor -- obstruction or swelling (croup)

Question 42

dullness to percussion, crackles, increased tactile fremitus suggest

Answer 42

consolidation

Question 43

dullness to percussion, decreased breath sounds, decreased tactile fremitus suggest

Answer 43

pleural effusion