RIPPA

Question 1

What causes an increased RR?

Answer 1

Airway obstruction.
Asthma, COPD, pneumonia, pulmonary fibrosis, pulmonary embolism, pneumothorax, lung collapse, pleural effusion.

Question 2

What causes a decreased RR?

Answer 2

Exhaustion, sedation.
Raised intracranial pressure.
Opiate overdose, intoxication.
Metabolic alkalosis.

Question 3

How can you inspect chest movement?

Answer 3

Symmetrical or asymmetrical.
Paradoxical - breathing causes the chest to move out, which is caused by flail chest (a segment of the ribcage becomes detached due to trauma) or phrenic nerve palsy.

Question 4

What are accessory muscles of breathing?

Answer 4

Sternocleidomastoids.
Scalene muscles.
Platysma (a broad sheet of muscle fibres extending from the collar bone to the jaw).

Question 5

What are different breathing sounds?

Answer 5

Noise - airway obstruction.
Stertor - pharynx obstruction.
Stridor (inspiratory) - larynx obstruction.
Wheeze (expiratory) - lower airway obstruction.

Question 6

What are the different chest shapes?

Answer 6

Barrel - asthma or emphysema.
Pigeon - severe childhood asthma.
Funnel - congenital (not clinically significant).

Question 7

What are the different chest scars?

Answer 7

From chest drains.
Pneumonectomy.
Tracheostomy.

Question 8

Why would a trachea deviate towards the pathology?

Answer 8

Pneumothorax.
Pneumonectomy / lobotomy.
Consolidation.
Atelectasis.

Question 9

Why would a trachea deviate away from the pathology?

Answer 9

Tension pneumothorax.
Pleural effusion.

Question 10

What causes reduced chest expansion?

Answer 10

Fibrosis.
Consolidation.
Effusion.
Pneumothorax.

Question 11

What causes hyper-resonant sounds?

Answer 11

Pneumothorax.
Emphysema.

Question 12

What causes dull sounds?

Answer 12

Pleural effusion.
Consolidation.
Pulmonary fibrosis.
Lung collapse.
Lobectomy.

Question 13

What causes stony dullness?

Answer 13

A large pleural effusion.

Question 14

Where is the upper border of liver dullness?

Answer 14

At the level of the 5th interspace anteriorly in the midclavicular line (lower in emphysema).

The lower border of lung resonance is at the 8th rib in the midaxillary line and the 10th rib posteriorly in the scapular line.

Question 15

What causes diminished breath sounds?

Answer 15

An abnormally thickened chest wall.
Emphysema.
Poor chest movement.
Fluid or air in the pleural cavity.
Pleural thickening.
Total obstruction of a large airway.
Lung/lobe collapse.

Question 16

What causes increased breath sounds?

Answer 16

An abnormally thin chest wall.
Over-breathing.

Question 17

What are the distinct characteristics of bronchial breathing?

Answer 17

A harsh resonant quality.
Equality in the length of the sounds heard during inspiration and expiration.
The expiratory sound has the same or higher pitch than the inspiratory sound.
A distinct pause between the sounds heard during inspiration and expiration.

Question 18

What does bronchial breathing, when heard over the lung fields, indicate?

Answer 18

Consolidation, fibrosis, or cavitations in the lung.
Usually accompanied by increased vocal resonance.

Question 19

What are wheezes?

Answer 19

Produced by air ‘whistling’ through narrowed bronchi, usually during expiration (asthma).

Question 20

What are crackles?

Answer 20

Predominantly at the end of inspiration.
May be altered by coughing.
Non-musical sounds.

Basal crackles in bed-ridden patients, which disappear on coughing or a few deep breaths, are usually of no significance.

Question 21

What are fine crackles?

Answer 21

The explosive reopening of peripheral small airways that have become blocked during expiration (pulmonary oedema).
The noise of ripping paper.

Question 22

What are coarse crackles?

Answer 22

Air bubbling through secretions in large airways (COPD).
The noise of walking through snow.

Question 23

What are rubs?

Answer 23

Often detected at the bases (lateral/posterior).
A creaking to-and-fro sound.
Heard in both inspiration and expiration.
Sounds close to the end of the stethoscope.
(Pneumonia, pulmonary embolism with infarction).

Question 24

What is an aegophony?

Answer 24

A bleating quality in voice sounds.
Usually at the upper limit of a pleural effusion.

Question 25

When would the expiratory phase of vesicular breathing be prolonged?

Answer 25

Airway narrowing (bronchitis, asthma).