thorax and lungs

Question 1

T7-8

Answer 1

interspace for thoracentesis

Question 2

floating ribs

Answer 2

rib 11 and 12

Question 3

articulate with costal cartilage above them

Answer 3

rib 8, 9, and 10

Question 4

manubrium of sternum

Answer 4

attached to sternum

Question 5

suprasternal notch

Answer 5

notch on top of the manubrium

Question 6

xyphoid process

Answer 6

on the end of the sternum

Question 7

right lung has how many lobes

Answer 7

3

Question 8

left lung has how many lobes

Answer 8

2

Question 9

apex of lungs found where

Answer 9

above clavicles

Question 10

c7 and t1

Answer 10

landmarks

Question 11

Five “A”s

Answer 11

Ask about tobacco use
Advise to quit
Assess willingness
Assist to quit
Arrange follow-up and support

Question 12

*Angle of Louis

Answer 12

sternal angle that joins the manubrium and sternum

Question 13

Dyspnea

Answer 13

shortness of breath

Question 14

*Wheezing

Answer 14

a continuous, course,whistling sound produced in the respiratory airways during breathing. Wheezes suggest narrowed airways, as in asthma, COPD, or bronchitis.

Question 15

cough

Answer 15

a reflex response to stimuli that irritate receptors in the larynx, trachea, or large bronchi

Question 16

hemoptysis

Answer 16

the expectoration of blood (or blood stained sputum) from the bronchi, larynx, trachea, or lungs

Question 17

parasthesias

Answer 17

sensations of tingling or “pins and needle” around the lips or extremities

Question 18

Hyperventilation

Answer 18

rapid, shallow breathing

Question 19

How to assess breathing

Answer 19

Rate - total number in one minute
Rhythm - cadence, regular vs. irregular
Depth - observed volume of air
Effort - objective measure of stress

Question 20

*Fremitus

Answer 20

palpable vibrations felt on the human body

Question 21

Lung Resonation

Answer 21

on percussion the note like sound that are measures by intensity, pitch, and duration in order to objectively determine the lungs volume of air

Question 22

*Crackles

Answer 22

Also called rales. Intermittent and brief explosive breath sounds. Usually leads to the Dx of cardiac or pulmonary conditions. Suggest abnormal lung tissue. Crackles may be from abnormalities of the lungs (pneumonia, fibrosis, early congestive heart failure) or of the airways (bronchitis, bronchiectasis)

Question 23

*Rhonchi

Answer 23

a low-pitched breath sound with snoring quality. Rhonchi suggest secretions in large airways.

Question 24

Normal Breathing

Answer 24

Normal Breathing 12 - 20 in adults

44 in infants

Question 25

Slow breathing

Answer 25

Bradypnea

Question 26

Bradypnea

Answer 26

Slow breathing. May be secondary to such causes as diabetic coma, drug induced respiratory depression, and increased intracrainal pressure.

Question 27

Sighing Respiration

Answer 27

Breathing punctuated by frequent sighs should be alert you to the possibility of hyperventilation syndrome - a common cause of dyspnea and dizziness. Occasional sighs are normal.

Question 28

Rapid Shallow Breathing

Answer 28

Tachypnea

Question 29

Tachypnea

Answer 29

Has a number of causes, including restrictive lung disease, pleuritic chest pain, and an elevates diaphragm

Question 30

Periods of deep breathing alternate with periods of apnea

Answer 30

Cheyne-Stokes Breathing

Question 31

Obstructive Breathing

Answer 31

Expiration is prolonged because narrow airways increase the resistance to airflow

Question 32

Causes of Obstructive breathing

Answer 32

Asthma, chronic bronchitis and COPD

Question 33

What rib does the Angle of Louis articulate with

Answer 33

rib 2

Question 34

2nd intercostal space

Answer 34

used during needle decompression for tension pneumothorax

Question 35

4th - 6th intercostal space

Answer 35

used for chest tube insertion

Question 36

Posterior Landmarks

Answer 36

c7 & t1; 12th rib; inferior tip of scapula (leads to the 7th rib)

Question 37

Pleximeter finger

Answer 37

Middle finger of your non-dominate hand. The finger that is struck during percussion.

Question 38

Plexor finger

Answer 38

The striking finger during percussion. Middle of your dominate hand.

Question 39

Chest expansion

Answer 39

Check chest expansion at the 10th rib

Question 40

bronchophony

Answer 40

Ask pt to say "99". Normal sound is muffled and indistinct.

Question 41

egophony

Answer 41

ask pc to say "ee". Normal is a muffled EE. Abnormal is a "ay" sound

Question 42

whispered pectoriloquy

Answer 42

Ask Pt to whisper "99". You should not be able to hear it well.

Question 43

Number of auscultation fields

Answer 43

14 posterior fields | 12 anterior fields

Question 44

Leading cause death preventable

Answer 44

Smoking

Question 45

Flu Shot Immunizations

Answer 45

For healthy people between 5 - 49 years Two types inactive vaccine nasal spray containing a live virus

Question 46

General techniques : lungs & thorax

Answer 46

1. Examine posterior while px is sitting & arms are folded. If px cannot sit then roll the px from one side to the other in the supine position slide 35 2. Examine anterior while px is supine. 3. IAPP

Question 47

Stridor

Answer 47

High pitched wheeze most likely from airway obstruction in the larynx or trachea

Question 48

AP diameter

Answer 48

AP diameter anteroposterior diameter

Question 49

AP diameter of chest

Answer 49

May increase with age, or COPD

Question 50

Auscultation of chest

Answer 50

Listen for 1. sounds generated by breathing 2. adventitious sounds 3. if abnormalities are present listen to the transmitted sounds as the px speaks

Question 51

The px should breath via their _____ during auscultation

Answer 51

mouth

Question 52

Normal breathing sounds : Vesicular

Answer 52

soft and low pitched; usually heard over most of both lungs

Question 53

Normal breathing sounds : Bronchial

Answer 53

louder and higher in pitch; usually heard over the manubrium

Question 54

Normal breathing sounds : Bronchovesicular

Answer 54

intermediate intensity and pitch; | usually heard over the 1st and 2nd interspaces

Question 55

Test chest expansion from ___ rib

Answer 55

the 10th

Question 56

When percussing the lower posterior you should stand somewhat to the ____ rather than directly behind

Answer 56

side

Question 57

When comparing two percussion's

Answer 57

Use the same percussion technique in both areas

Question 58

Five percussion notes

Answer 58

``` Flatness - thigh dullness - liver resonance - healthy lung hyperresonance - not normal, COPD lung tympany - gastric air bubble, puffed cheek ```

Question 59

Percussion of the anterior chest - heart

Answer 59

the heart normally produces an area of dullness to the left of the sternum from the 3rd to 5th intercostals

Question 60

Palpation 4 potential uses

Answer 60

1. Identification of tender areas 2. Assessment of observed abnormalities 3. Further assessment of chest expansion 4. Assessment of tactile fremitus

Question 61

"Walk test"

Answer 61

1. assesses the pulmonary function 2. ask the px to walk 8 feet at patients pace, repeat and note a faster time 3. normal 3.1 seconds; geriatrics 5.6 seconds 4. Observe px rate; effort; breathing sounds

Question 62

Forced expiratory time

Answer 62

Test for COPD use diaphragm of stethoscope over trachea; time duration of audible expiration; get 3 readings; norm >8 seconds; >60 y/old w/time of 6 - 8 seconds are twice as likely to have COPD *Ask the patient to take a deep breath in and then breathe out as quickly and completely as possible with mouth open. Listen over the trachea with the diaphragm of a stethoscope and time the audible expiration. Try to get three consistent readings, allowing a short rest between efforts if necessary.

Question 63

Identification of fractured rib

Answer 63

Posterior/anterior compression; squeeze palms on sternum and thoracic spine; Rule out fracture vs. soft injury With one hand on the sternum and the other on the thoracic spine, squeeze the chest. Is this painful, and where?

Question 64

Crackles wheezes or Rhonchi clears with cough with this infection

Answer 64

Bronchitis