Thorax and lungs

Question 1

Define Adventitious breath sounds

Answer 1

abnormal auscultated breath sounds like crackles, rhonchi, wheezes and friction rub

Question 2

Define Atelectasis

Answer 2

incomplete expansion of the lung

Question 3

Define Barrel chest

Answer 3

increased AP diameter, often with some degree of kyphosis - COPD

Question 4

Define Biot respirations

Answer 4

irregular respirations varying in depth and intermittent apnea intervals, no repetitive pattern

Question 5

Define Bronchiectasis

Answer 5

chronic dilation of the bronchi or bronchioles, caused by repeated infections of bronchial obstructions

Question 6

Define Bronchophony

Answer 6

exaggeration of vocal resonance emanating from a bronchus surround by consolidated lung tissue

• greater clarity and increased loudness of spoken word

Question 7

Define COPD

Answer 7

nonspecific diagnosis of decreased ability of lungs to ventilate - includes chronic bronchitis and emphysema

Question 8

Define Egophony

Answer 8

consolidated lung tissue, e’s turn to a’s

Question 9

Define Vesicular

Answer 9

normal breath sounds:

low pitch, soft, short expirations

Question 10

Define Tubular

Answer 10

normal breath sounds: heard only over trachea, high pitch; loud and long expirations, longer than inspiration

Question 11

Define Bronchovesicular

Answer 11

normal breath sounds:

heard over main bronchus area and over upper right posterior lung field; medium pitch; expiration equals inspiration

Question 12

Define Othopnea

Answer 12

SOB, lying down

Question 13

Define Pectoriloquy

Answer 13

striking transmission of voice sounds through pulmonary structures so they are clearly audible through stethoscope - lung consolidation

Question 14

Define Pectus carinatum

Answer 14

Pigeon chest:

forward protrusion of sterum

Question 15

Define Pectus excavatum

Answer 15

Funnel chest:

depression of sternum

Question 16

Define Tactile fremitus

Answer 16

tremor or vibration in any body part detected on palpation

Question 17

Define Whispered pectoriloquy

Answer 17

whisper heard same way as normal speech when lung is consolidated by pneumonia

Question 18

Most sensitive place in chest to look for fluid?

Answer 18

Sulcuses where diaphragm meets chest wall

Question 19

Boundaries of horizontal fissure

Answer 19

with inhalation = 4th rib at sternum, 5th rib at midaxillary line

Question 20

Boundaries of oblique fissure

Answer 20

with inhalation = 6th rib at midaxillary line

Question 21

Basic ausculatation vs. detailed

Answer 21

6 points vs 12

Question 22

Normal diaphragm movement height

Answer 22

4 cm

Question 23

What’s important about right mainstem bronchus?

Answer 23

Runs straighter than the left. Aspirated object will more likely be here.
Bifurcation of right and left occurs at sternal angle (2nd rib)

Question 24

Thorax and lungs physical exam - order?

Answer 24

1. LOOK: assess for stability
2. Listen
3. Palpate
4. Percuss

Question 25

Things to LOOK for in PE:

Answer 25

Shape, movement, posture (walking), acting*, accessory muscles

Cyanosis, clubbing, edema, bad odor to breath, needle marks

*Accessory muscle use is another form of acting ill

Question 26

Tripoding

Answer 26

maximize air space, COPD, epiglottitis

Question 27

Bell use

Answer 27

light touch, just seal skin
heart sounds
*must be on skin

Question 28

Diaphragm use

Answer 28

dimpling skin is ok

lungs

Question 29

Where to percuss middle lobe?

Answer 29

in front

Question 30

Pulmonary embolism on palpation

Answer 30

localized collapse so ribs don’t move over area with embolism

Question 31

Pneumonia on palpation

Answer 31

feel fremitus with consolidation

Question 32

COPD PE

Answer 32

thorax symmetric with moderate kyphosis and increased AP diameter, decreased expansion, hyperresonant lungs, distant breath sounds, delayed expiratory phase, scattered exp. wheezes, diaphragm descent 2 cm bilaterally.
fremitus decreased; no bronchophony/egophony or whispered pectoriloquy.

Question 33

Asthma PE

Answer 33

thorax symmetric with flattened kyphosis and normal AP diameter (use secondary muscles of respiration), lungs are resonant (unless bronchial plug), broncho-vesicular breath sounds and scattered expiratory wheezes bilaterally (stronger with forced expiration)
No bronchophony, egophony, or whispered pectoriloquy.
Diaphragms descend 4cm bilat.

Question 34

Pneumothorax PE

Answer 34

thorax asymmetry, decreased movement on one side, hyperresonant lung on that side, BS decreased on that side in all lobes, diaphragms descend 4 cm on the opposite side only