CH: 19 Thorax and Lungs

Question 1

suprasternal notch location?

Answer 1

top of sternum between clavicles
*hollow U shaped depression

Question 2

what is the manubriosternal angle known as?

Answer 2

angle of Louis

Question 3

manubriosternal angle lines up with?

Answer 3

2nd rib

Question 4

location of 1st rib?

Answer 4

below clavicle

Question 5

are intercostal spaces above or below ribs?

Answer 5

below
ex. 7th intercostal space below 7th rib

Question 6

what is the costal angle?

Answer 6

right and left costal margins form angle where they meet at the Xiphoid process
*usually 90 degrees or less

Question 7

how many ribs on the front?

Answer 7

11

Question 8

how many ribs on the back?

Answer 8

12

Question 9

which ribs attach directly to the sternum via costal cartilage?

Answer 9

1-7

Question 10

which ribs attach to the costal cartilage above?

Answer 10

8, 9, 10
*7’s cartilage attaches to sternum, 8’s cartilage attaches to 7’s cartilage

Question 11

which ribs are floating?

Answer 11

11 and 12

Question 12

what is the bony prominence at the top of the neck?

Answer 12

spinous process of C7

Question 13

where is the midsternal line?

Answer 13

down middle of sternum anteriorly

Question 14

where is the midclavicular line?

Answer 14

the middle of the clavicle anteriorly

Question 15

where is the midspinal/vertebral line?

Answer 15

down middle of back/spine posteriorly

Question 16

where is the scapular line?

Answer 16

middle of scapula posteriorly

Question 17

where is the anterior axillary line?

Answer 17

between anterior arm and chest

Question 18

where is the midaxillary line?

Answer 18

middle of axillary laterally

Question 19

posterior axillary line?

Answer 19

between posterior deltoid and back

Question 20

what is contained in the mediastinum?

Answer 20

esophagus
trachea
heart
great vessels

Question 21

what is contained in the right and left pleural cavities?

Answer 21

the lungs

Question 22

apex of lung location?

Answer 22

above the clavical

Question 23

base of lung location?

Answer 23

rests on diaphragm at about the 6th rib at midclavicular

Question 24

how many lobes does the right lung have?

Answer 24

three (middle lobe)

Question 25

how many lobes does the left lung have?

Answer 25

two

Question 26

which lobe dominates the posterior region?

Answer 26

LOWER lobe

Question 27

which lobe is SHORTER?

Answer 27

right *because of underlying liver

Question 28

which lobe is NARROWER?

Answer 28

left *because heart bulges to the left

Question 29

use of accessory muscles usually indicates?

Answer 29

trouble breathing, possible respiratory distress

Question 30

why is surface area important?

Answer 30

so alveoli have space for gas exchange

Question 31

what is atelectasis?

Answer 31

alveolar collapse

Question 32

what is decubitus positioning?

Answer 32

lay flat and lift head *to see fluid movement

Question 33

what do loop diuretics help with?

Answer 33

ventilation and gas exchange *they get rid of fluid

Question 34

respiratory system mechanic functions?

Answer 34

chest size change during respiration inspiration expiration control of respiration (breathing rate controlled by baroreceptors controlled by brain stem)

Question 35

coughing up blood is called?

Answer 35

hemoptysis *could indicate lung cancer

Question 36

pulmonary edema cough produces?

Answer 36

thick, pink, frothy sputum *could lead to respiratory arrest, emergent

Question 37

what color sputum with TB?

Answer 37

rust

Question 38

bacterial/viral production?

Answer 38

green/yellow color *ex. bronchitis

Question 39

SOB is a concern _____?

Answer 39

at rest

Question 40

takes deep breath and chest pain stays the same, possible cause?

Answer 40

heart/MI

Question 41

takes deep breath and chest pain worsens, possible cause?

Answer 41

lungs

Question 42

orthopnea?

Answer 42

difficulty breathing in supine position

Question 43

what is anteroposterior diameter?

Answer 43

distance from front to back when looking from the side

Question 44

what is transverse diameter?

Answer 44

true width of patient when looking straight at anterior

Question 45

normal AP diameter?

Answer 45

1:2 ratio

Question 46

barrel chest AP diameter?

Answer 46

1:1 ratio - hyperinflation *usually in COPD

Question 47

assessment order for thorax and lungs?

Answer 47

inspect palpate percuss auscultate

Question 48

organs sound ___?

Answer 48

dull

Question 49

bones sound ___?

Answer 49

flat

Question 50

in percussion, normal healthy lung sounds?

Answer 50

resonance -low pitched, clear, hollow

Question 51

in what diseases might you see accessory muscle use?

Answer 51

COPD ARDS asthma respiratory infection chronic bronchitis pneumonia emphysema pulmonary edema pulmonary embolism

Question 52

positioning for respiratory distress?

Answer 52

tripod

Question 53

thumb placement during symmetric expansion?

Answer 53

9th rib *normal should be bilaterally symmetric

Question 54

who might not have bilaterally symmetric expansion?

Answer 54

atelectasis (collapsed lung/alveoli) pneumonia pneumothorax lobotomy

Question 55

what does tactile fremitus assess?

Answer 55

vibration of larynx through bronchi

Question 56

who might not have equally bilateral tactile fremitus?

Answer 56

lung disease pneumonia

Question 57

who might have decreased tactile fremitus?

Answer 57

asthma pleural effusion atelectasis *with hyperinflation

Question 58

what are the three breath sounds?

Answer 58

bronchial bronchovesicular vesicular

Question 59

which breath sound is the loudest with high pitch, hollow quality, expiration>inspiration?

Answer 59

bronchial

Question 60

which breath sound is moderate pitch and amplitude, mixed quality, expiration=inspiration?

Answer 60

bronchovesicular

Question 61

which breath sound is quieter with low pitch, rustling quality, inspiration>expiration?

Answer 61

vesicular

Question 62

main airway sounds?

Answer 62

vesicular

Question 63

peripheral field sounds?

Answer 63

vesicular

Question 64

is the diaphragm better for high or low pitched?

Answer 64

high pitched *bell for low pitched

Question 65

crackles sound and cause?

Answer 65

discontinuous popping, like rice crispies high pitched *caused by inhaled air colliding with deflated airway *inspiration, expiration, or both

Question 66

wheezes sound and cause?

Answer 66

continuous high pitched whistling *caused by airway constriction *inspiration, expiration, or both

Question 67

rhonchi sound and cause?

Answer 67

continuous low pitched snoring quality *caused by secretions in large airway *inspiration, expiration, or both

Question 68

stridor sound and cause?

Answer 68

continuous high pitched wheeze in upper airway *caused by obstruction or narrowing, associated with anaphylaxis late response *usually heard on inspiration, listen over trachea

Question 69

bronchophony sound?

Answer 69

have patient say 99 *muffled is normal *clear indicates fluid or mucus in lungs

Question 70

egophony sound?

Answer 70

whisper 99 *clear sound is abnormal

Question 71

whispered pectoriloquy?

Answer 71

have patient say "e"- if sounds like "a" indicates fluid accumulation

Question 72

are breath/lung sounds louder through vesicular or bronchial tubes?

Answer 72

bronchial *vesicular is quieter

Question 73

cyanosis occurs with?

Answer 73

tissue hypoxia

Question 74

what is rhonchal fremitus?

Answer 74

palpable with thick bronchial secretions

Question 75

what is pleural friction fremitus?

Answer 75

palpable with pleura inflammation

Question 76

what is crepitus?

Answer 76

coarse, crackling palpable over skin surface (rice crispies) *happens when SUBQ air escapes lung and enters SUBQ tissue

Question 77

what is hyperresonance?

Answer 77

low pitched booming sound when too much air is present

Question 78

6 min walk?

Answer 78

measures pulmonary rehab stop if breathlessness or if O2 below 85

Question 79

what happens during sleep apnea?

Answer 79

tongue falls back and obstructs airway

Question 80

kyphosis usually from___?

Answer 80

degenerative disease

Question 81

sighs are purposeful to___?

Answer 81

expand alveoli

Question 82

tachypnea?

Answer 82

rapid, shallow breathing

Question 83

bradypnea?

Answer 83

slow rate

Question 84

hyperventilation?

Answer 84

increased rate AND depth

Question 85

hypoventilation?

Answer 85

decreased rate AND depth

Question 86

Cheyne-Stokes breathing?

Answer 86

wax and wane (increase and decrease) until apnea in regular pattern *seen most commonly with heart failure

Question 87

Biot's respiration?

Answer 87

same as CSB but irregular pattern *seen with head trauma

Question 88

chronic obstructive breathing?

Answer 88

normal inspiration and prolonged expiration *leads to air trapping

Question 89

kidneys make___?

Answer 89

BICARB lungs drive Co2 Co2 is acidic pH down when acidic and up when basic

Question 90

COPD is similar to____?

Answer 90

asthma *asthma reversible, COPD is not (chronic)