2.1 Pulmonary Assessment

Question 1

Suprasternal notch
Sternal angle (angle of Louis)
Costal angle

Answer 1

鎖骨中間 胸骨最上
胸骨突
胸骨底

Question 2

Mid sternal line
Right/left midclavicular line

Answer 2

Anterior chest

Question 3

Vertebral line
Right/left scapular line

Answer 3

Posterior thorax

Question 4

Right/left anterior/posterior axillary line

Answer 4

Lateral

Question 5

Physical assessment order

Answer 5

IPPA

Question 6

Nasal flaring

Answer 6

Seen in Laboured respiration, hypoxia

Question 7

Central vs peripheral cyanosis

Answer 7

Central: dusky or blue tongue, buccal mucus
Peripheral: blue,dusky red or purple lips, nail bed, tips of nose and ear

Question 8

Clubbing of finger

Answer 8

Chronic hypoxia
Angle between nail and nail bed >180
DPD>IPD

Question 9

Accessory muscle for breathing

Answer 9

E.g. abdominal muscles
COPD, respiratory muscle fatigue

Question 10

Intercostal space
retraction
Bulging

Answer 10

-Retraction 收縮
COPD, asthma
-Bulging 突
COPD, pneumothorax, massive pleural effusion

Question 11

Normal transverse diameter to anteroposterior diameter ratio

Answer 11

2:1

Question 12

Barrel chest

Answer 12

Ratio 1:1
Normal aging and hyperinflation of lung

Question 13

Kyphosis

Answer 13

Abnormal curvature
Significant back pain and limited mobility

Question 14

Pectus excavatum (Funnel chest)

Answer 14

Depression of lower part of sternum

Question 15

Pectus carinatum (Pigeon chest)

Answer 15

Protrusion of sternum

Question 16

Scoliosis

Answer 16

Unequal shoulder, scapula and hip height

Question 17

Tripod position

Answer 17

Leading forward to alleviate SOB

Question 18

Eupnea breathing rate

Answer 18

12-20

Question 19

Kussmaul’s resouration

Answer 19

Deep and fast
E.g. DKA

Question 20

Cheyne-stroke respiration

Answer 20

Regularly irregular
fast, slow, apnea, slow, fast, slow
Related to brain(ICP)

Question 21

Biot’s respiration

Answer 21

Irregular depth and rate with apnea
(Increase in intracranial pressure)

Question 22

Tenderness

Answer 22

Pain upon touching

Question 23

Lesions

Answer 23

疹

Question 24

Crepitus

Answer 24

Touch like bubble paper
Due to subcutaneous emphysema

Question 25

Posterior Thoracic expansion Place trumps closer to vertebral line at level of T_/T_ Normal finding: ___cm symmetrical expansion

Answer 25

T9/10 2.5

Question 26

Anterior Thoracic expansion: Place thrums along costal margin toward xiphoid process Normal finding: __-__ cm symmetrical expansion Indication of abnormality

Answer 26

5-10 - bilateral decreased expansion: COPD - unilateral : chest trauma, pneumothorax

Question 27

Percussion Sound over: Lung field Ribs Heart liver spleen Stomach

Answer 27

Resonance Flats Dullness Tympany

Question 28

Diaphragmatic excursion Normal findings Indication of abnormal

Answer 28

呼&吸underline搵肺伸縮幾多 Bilaterally equal: 3-5cm in adult, 7-8 in well-condition people Abnormal (decrease/absence of excursion): Pleural effusion, hyperinflation (COPD), atelectasis

Question 29

Auscultation of bronchial

Answer 29

Trachea area I = E (similar) / I < E (slightly)

Question 30

Auscultation of vesicular

Answer 30

Lung base, peripheral lung field I>E 3:1

Question 31

Auscultation of bronchovesicular

Answer 31

Main bronchus area I=E

Question 32

Fine crackles

Answer 32

燒火柴 Discontinuous sounds Mainly inspiration Alveolar collapse by secretion reopen Pneumonia, atelectasis

Question 33

Coarse crackles

Answer 33

Discontinuous sounds Air pass through airway COPD, pneumonia, pulmonary edema

Question 34

Rhonchi

Answer 34

Large airway large secretion Turbulence of air COPD pneumonia

Question 35

Wheezing

Answer 35

Wuwuwu when exhale Need more time to exhale due to obstruction Asthma COPD

Question 36

Stridor

Answer 36

High pitch wuwuwu Obstruction of upper airway

Question 37

Pleural rub

Answer 37

Inflamed pleural tissue rubbing