Thorax and lungs

Question 1

Where would you insert a needle for a tension pneumothorax in the chest?

Answer 1

2nd intercostal space, midclavicular line

Question 2

Where would you insert anterior axillary line for a chest tube insertion?

Answer 2

4th intercostal space

Question 3

Where would you perform a thoracocentesis to remove blood or pus?

Answer 3

t7-t8 intercostal space

Question 4

In which lobe is aspiration pneumonia more common?

Answer 4

RUL/RML

Question 5

What are some physical exam clues to look out for with CP?

Answer 5

• finger pointing at a spot most likely muscular
• hand moving from neck to epigastrium most likely heartburn
• closed fist over sternum, most likely agina pectoris

Question 6

What are some of the possibilities if a pt presents w/ CP?

Answer 6

Myocardium – angina pectoris, myocardial infarction, myocarditis
Pericardium – pericarditis
Aorta – aortic dissection
Trachea/bronchi – bronchitis
Parietal pleura – pericarditis, pneumonia, pneumothorax, pleural effusion, pulmonary embolus
Esophagus – GERD, esophageal spasm, esophageal tear
Extrathoracic – cervical arthritis, biliary colic, gastritis

Question 7

What are telltale sx of cardiac and pulmonary disease?

Answer 7

dyspnea and wheezing

Question 8

What can cause fould smelling sputum?

Answer 8

lung abcess

Question 9

What is the order to follow when inspecting the lungs?

Answer 9

inspect
palpate
percuss
auscultate

Question 10

What should you be observing on PE for chest?

Answer 10

rate, rhythm, depth and effort of breathing

Question 11

What is an ominous sign of upper airways obstruction?

Answer 11

Stridor (audible high pitched whistling)

Question 12

What can be some causes of chest expansion test failure?

Answer 12

• chronic fibrosis of underlying lung/pleura
• pleural effusion
• lobar pneumonia
• unilateral bronchial obstruction

Question 13

What can be some causes of decreased

asymmetrical tactile fremitus?

Answer 13

Asymmetric decreased:
  - pleural effusion
  - pneumothorax
  - neoplasm
Asymmetric increased:
 - pneumonia

Question 14

What will healthy lungs sound like on percussion?

Answer 14

resonant

Question 15

What will lungs w/ fluid/solid sound like on percussion?

Answer 15

dullness

Question 16

When will you hear hyperresonance to percussion in the lungs?

Answer 16

COPD/asthma

Question 17

What does resonance sound like?

Answer 17

loud intensity, low pitch, e.g., normal lung

Question 18

What does hyperresonance sound like?

Answer 18

very loud intensity, low pitch. e.g fully inflated lung

emphysema, unilateral pneumothorax

Question 19

What does tympany sound like?

Answer 19

loud intensity, high pitch, e.g., gastric bubble/puffed out cheek
(cavity or large pneumothorax)

Question 20

What does dullness sound like?

Answer 20

Medium intensity, medium pitch e.g., liver

lobar pneumonia, stelectasis

Question 21

What does flatness sound like?

Answer 21

soft intensity, high pitch, e.g., thigh

pleural effusion

Question 22

What are characteristics of vesicular breath sounds and where will you hear them?

Answer 22

low pitched, soft rustling sound

• heard everywhere on thoracic wall across the lung

Question 23

What are characteristics of bronchial breath sounds and where will you hear them?

Answer 23

• high pitched, tubular, hollow sound

- over manubrium of the sternum

Question 24

What are characteristics of tracheal breath sounds and where will you hear them?

Answer 24

high pitched, very loud, harsh

• over the trachea on the throat

Question 25

What are characteristics of bronchovesicular breath sounds and where will you hear them?

Answer 25

• intermediate pitch, intermediate sound

- over 1st and 2nd interspaces anteriorly between the scapula

Question 26

What are some types of adventitious sounds (added sounds) you may hear?

Answer 26

Crackles (rales)
Wheezes
Rhochi

Question 27

What can cause rales/crackles?

Answer 27

• air bubbles flowing through secretions or lightly closed airways during respiration
• result from a series of tiny explosions when small airways pop open during inspiration

Question 28

What is wheezing and what does it suggest?

Answer 28

• is a high pitched, shril, hissing quality

- it suggests narrow airways (like asthma, bronchitis, COPD, unilaterally)

Question 29

What does rhochi sound like and what can cause it?

Answer 29

• is a low pitch, snoring quality, rumbling

- caused by air passing over secretion such as mucous plugs (asthma, bronchitis, COPD)

Question 30

What causes friction rub?

Answer 30

inflamed, rough surfaces rubbing together (over lungs=pleurisy, over the heart pericardium= pericarditis)

Question 31

What is mediastinal crunch (Hamman sign)?

Answer 31

• Found with mediastinal emphysema (air in the mediastinum)

- is a variety of noises synchronous w/ heart beat, not w/ respiration

Question 32

What is lobar pneumonia?

Answer 32

• alveoli are filled w/ fluid/debris in consolidation

- will have increased voice sounds due loss of airflow

Question 33

What will happen to transmitted voice sounds w/ pleural effusion (dull lung) or hyperinflated lung (hyperresonant)?

Answer 33

• decreased/absent transmitted voice sound

Question 34

What does it mean if “ee” changes to “aa” in egophony?

Answer 34

lobar consolidation from pneumonia

Question 35

What does it meant if you are able to hear the pt say 99 in broncophony?

Answer 35

• There is a loss of airspace

Question 36

What does it mean if the whispered 99 is loud in whispered pectriloqy?

Answer 36

• there is a loss of airspace