Thorax and Lung Exam

Question 1

Tactile Fremitus

Answer 1

palpable vibrations transmitted through the chest wall when patient speaks

Question 2

Increased tactile fremitus could be __________

Answer 2

INCREASE in lung density
Consolidation (PNA, PE)
Pulmonary fibrosis

Question 3

Decreased tactile fremitus could be ____________

Answer 3

Lung tissue is REPLACED by fluid or air
Pleural effusion
Emphysema/COPD
Pneumothorax
Foreign body

Question 4

What is the difference between Consolidation and pleural effusion?

Answer 4

Consolidation: Lung is engorged with fluid
Effusion: Lung tissue is replaced by fluid or air

Question 5

Vesicular BS

Answer 5

Normal breath sounds. Soft, relatively low pitched. Heard at ends of bronchiole branches in alveoli. Abnormal if heard over trachea or bronchii

Question 6

Bronchovesicular BS

Answer 6

May not exist, inbetween 1st and 2nd interspaces anteriorly and between scapulae

Question 7

Bronchial/Tubular BS

Answer 7

Abnormal if heard anywhere but over bronchial area. REaltively high pitched.

Question 8

Tracheal BS

Answer 8

Relatively high pitched, harsh; heard over trachea and neck. “Darth Vader”

Question 9

Stridor

Answer 9

a wheeze that is entirely or predominantly inspiratory. Partial obstruction of trachea or larynx

Question 10

Things to note for adventitious BS

Answer 10

Timing: insp. and/or exp.
Location: LUL/RML, scattered…
Number: intermittent, continuous
Change: coughing or position?

Question 11

Egophony is common in __________

Answer 11

Emphysema

Question 12

Pleural effusion

Answer 12

Fluid displacing the lung space compressing the lung. Pushes everything to opposite side.

Question 13

Right lung has ____lobes, left lung has ____ lobes

Answer 13

3, 2

Question 14

oblique fissures divide the ____ and ____ lobes

Answer 14

upper and lower

Question 15

the horizontal fissure is only in the ____ lung and creates the ____ lobe

Answer 15

right, middle

Question 16

Where is the lung apex?

Answer 16

about 4cm superior to the first rib

Question 17

Where is are the lower borders?

Answer 17

Between T9 and T12 depending on inspiration or expiration

Question 18

Fine crackles are heard when?

Answer 18

End of inspiration, and coughing won’t clear

Question 19

When are course crackles heard?

Answer 19

Entire inspiration, loud and bubbly

Question 20

Ronchi are?

Answer 20

low pitched snoring, honking sounds

Question 21

Vocal fremitus tests

Answer 21

egophony, whispered pectoriliquy, bronchophony, in each of these if words are louder, clearer, mean consolidation or pneumonia, but if none, assumes some sort of effusion

Question 22

Diaphragmatic excursion normal measurement

Answer 22

3-5 cm, diaphragm usually higher on the right as it sits on the liver

Question 23

barrel chest

Answer 23

due to intercostal musculature growing - seen in emphysema

Question 24

flail chest

Answer 24

when a section of the chest is disconnected from the bony structure and creates paradoxical chest movement

Question 25

scoliosis

Answer 25

spine deviated laterally

Question 26

Kyphosis

Answer 26

spine deviated posteriorly (hunch)

Question 27

gibbus

Answer 27

Sharp angular deformity associated with a collapsed vertebrae

Question 28

Lordosis

Answer 28

inward curvature of inner spine, seen in pregnancies

Question 29

Hemoptysis

Answer 29

coughing up blood

Question 30

pulsus paradoxus

Answer 30

decrease of 10 mm Hg or more during inspiration, or increased pulse during expiration