Thoracic exam and findings

Question 1

What is the order of examination techniques?

Answer 1

Observe/Inspect, percuss, palpate, auscultate.

Question 2

When inspecting the chest what do you look for?

Answer 2

Shape and symmetry
Chest wall movement
Superficial venous patterns
Prominence of ribs
Anteroposterior vs. transverse diameter
Barrel chest
Sternal protrusion
Spinal deviation

Question 3

What periphial clues may suggest cardiovascular issues?

Answer 3

Fingers: clubbing
Breath: odor
Skin, nails, and lips: cyanosis or pallor
Lips: pursing
Nostrils: flaring

Question 4

When inspecting respiration, what do you look for?

Answer 4

Rate
Quality
Pattern

Question 5

When observing chest respirations, what do you need to be looking for?

Answer 5

-Symmetry

-Retractions are when the chest wall seems to cave in at the sternum, between the ribs, at the suprasternal notch, above the clavicles, and at the lowest costal margins.
Suggests an obstruction to inspiration at any point in the respiratory tract

-Paradoxic breathing: on inspiration, the lower thorax is
drawn in, and on expiration, the opposite occurs.

Question 6

When palpating the thoracic muscles and skeleton, be looking for the following:

Answer 6

Pulsations
Tenderness
Bulges/depressions
Masses
Unusual movement/positions
Elasticity of rib cage
Immovability of sternum
Rigidity of thoracic spine

Question 7

When palpating for thoracic expansion, what would signal an abnormality?

Answer 7

Loss of symmetry in the movement of the thumbs suggests a problem on one or both sides.

Question 8

What is tactile fermitius?

Answer 8

Palpable vibration of the chest wall that results from speech or other verbalizations

Question 9

When percussing over the lungs, what does Hyperresonance signify?

Answer 9

hyperinflation

Question 10

When percussing over the lungs, what does dullness signify?

Answer 10

diminished air exchange

Question 11

When percussing over the lungs, what is the normal sound that should be heard?

Answer 11

resonance

Question 12

What four areas can auscultation sounds be listed under?

Answer 12

Intensity
Pitch
Quality
Duration

Question 13

When auscultating for breath sounds what does vesicular sound like?

Answer 13

Low-pitched, low-intensity sounds heard over healthy lung tissue

Question 14

When auscultation for breath sounds what does bronchovesicular sound like?

Answer 14

Heard over the major bronchi and are typically moderate in pitch and intensity

Question 15

What do bronchial breath sounds sound like?

Answer 15

Highest in pitch and intensity

Ordinarily heard only over the trachea

Question 16

Where are vesicular sounds heard, typically?

Answer 16

Over peripheral lung tissue.

Question 17

Where are bronchovesicular sounds heard?

Answer 17

2nd and 3rd intercostal space on anterior chest; possibly in between the scapula on the posterior chest.

Question 18

What are the four Adventitious breath sounds?

Answer 18

Crackles (rales), rhonchi (sonorous wheezes), Wheezes (sibilant wheeze), and friction rub

Question 19

Describe a crackle(rale) and what are the two types?

Answer 19

Abnormal respiratory sound heard more often during inspiration and characterized by discrete discontinuous sounds
Fine: high pitched, and relatively short in duration
Coarse: low pitched, and relatively longer in duration

Question 20

Describe rhonchi and what causes it?

Answer 20

Deeper, more rumbling, more pronounced during expiration, more likely to be prolonged and continuous, and less discrete than crackles
Caused by the passage of air through an airway obstructed by thick secretions, muscular spasm, new growth, or external pressure

Question 21

Describe a wheeze and what causes it.

Answer 21

Continuous, high-pitched, musical sound (almost a whistle) heard during inspiration or expiration
Caused by a relatively high-velocity air flow through a narrowed or obstructed airway
May be caused by the bronchospasm of asthma (reactive airway disease) or acute or chronic bronchitis

Question 22

Describe a friction rub and what causes it.

Answer 22

Occurs outside the respiratory tree
Dry, crackly, grating, low-pitched sound and is heard in both expiration and inspiration
Caused by inflamed, roughened surfaces rubbing together

Question 23

Describe bronchophony, Pectoriloquy, and Egophony.

Answer 23

Bronchophony
Greater clarity and increased loudness of spoken sounds
Pectoriloquy
Extreme bronchophony where even a whisper can be heard clearly through the stethoscope
Egophony
Intensity of the spoken voice is increased and there is a nasal quality.
e’s become stuffy broad a’s