CPT I - PRACTICAL 1

Question 1

What bone and lung anatomy correlates with T3?

Answer 1

Spine of scapula

Oblique fissure

Question 2

What scapula and rib anatomy correlates with T7?

Answer 2

Inferior angle of scapula

Rib 8 directly across

Question 3

What rib attaches to sternal angle? What segment of the lung?

Answer 3

Rib 2

Anterior segment of upper lobes

Question 4

What is the costophrenic angle?

Answer 4

Inferior angle of thorax formed by costal cartilages of ribs

Question 5

SCM innervation?

Answer 5

Accessory nerve (CN XI)

Question 6

Scalenes innervation?

Answer 6

C4-C8

Question 7

Upper traps innervation?

Answer 7

Spinal Accessory nerve (CN XI)

Question 8

Abs innervation?

Answer 8

T5-L1

Question 9

Where does the oblique fissure start and end?

Answer 9

Spinous process of T3

6th costochondral at midclavicular line

Question 10

Where does horizontal fissure start and end?

Answer 10

Oblique fissure at midaxillary line

4th costochondral at sternum

Question 11

Where does the cardiac notch start and end?

Answer 11

4th costochondral at sternum

6th rib at midclavicular line

Question 12

What kind of valve is Aortic? Where do you listen to it? What parts of the heart does it separate?

Answer 12

AV valve is semilunar

At R sternal border, 2nd IC space

Left ventricle –> aorta

Question 13

What kind of valve is Pulmonic? Where do you listen to it? What parts of the heart does it separate?

Answer 13

PV valve is semilunar

At L sternal border, 2nd IC space

Right ventricle –> pulmonary artery

Question 14

What kind of valve is Tricuspid? Where do you listen to it? What parts of the heart does it separate?

Answer 14

TV valve is atrioventricular

At L sternal border, 5th IC space

Right atrium –> ventricle

Question 15

What kind of valve is Mitral? Where do you listen to it? What parts of the heart does it separate?

Answer 15

MV valve is atrioventricular

At midclavicular line, 5th IC space

Left atrium –> ventricle

Question 16

What is S1? Where is it best heard?

Answer 16

Closure of AV valves
Start of systole

Best heard at mitral valve

Question 17

What is S2? Where is it best heard?

Answer 17

Closure of the SL valves
Start of diastole

Best heard at aortic valve

Question 18

What is S3? Clinical indication?

Answer 18

Ventricular gallop occurring right before diastole (lub-dub-dub)

Indicates CHF

Poor ventricular compliance, turbulent flow in early diastole

Question 19

What is S4? Clinical indication?

Answer 19

Atrial gallop occurring right before systole (la-lub-dub)

Indicates many cardio or pulmonary disorders; may be normal in children/young adults

Exaggerated atrial contraction, turbulent flow in late diastole

Question 20

What is the normal sequence of breathing (3 parts)

Answer 20

Abdominal rise
Lateral costal expansion
Upper chest expansion

Question 21

Which is longer: inhalation or exhalation?

Answer 21

Inhalation

Question 22

What is jugular venous distention a sign of?

Answer 22

Right-sided heart failure

Question 23

What is bilateral lower extremity edema a sign of?

Answer 23

Right-sided heart failure

Question 24

What is unilateral LE edema a sign of?

Answer 24

DVT or blockage of lymphatic system

Question 25

What part of the stethoscope do you use for heart sounds? For lung sounds?

Answer 25

Heart: diaphragm (s1-2) and bell (s3-4) Lung: diaphragm

Question 26

Where are murmurs heard best?

Answer 26

Loudest at affected valve

Question 27

What are the 3 normal sounds of ventilation?

Answer 27

Tracheal/bronchial Bronchovesicular Vesicular

Question 28

What is a wheeze?

Answer 28

High pitch - narrowing of airways, especially on inhalation typically

Question 29

What is a crackle?

Answer 29

Bubbles/popping - fluid or secretions, airway opening

Question 30

What is pleural rub?

Answer 30

Grating/friction - inflammation, pleura rubbing together

Question 31

What is bronchophony?

Answer 31

Alveoli filled with fluid or replaced by soft tissue

Question 32

What is egophony?

Answer 32

Bleating sound often by lung consolidation and fibrosis

Question 33

What is whispered pectoriloquy?

Answer 33

Increased loudness of whispering

Question 34

Where do you test upper chest expansion symmetry?

Answer 34

thumbs at sternal notch (jugular notch)

Question 35

Where do you test diaphragmatic expansion symmetry?

Answer 35

thumbs at xiphoid process

Question 36

Where do you test lateral costal expansion symmetry?

Answer 36

thumbs inside inferior angle (cup the angle with thumb and index)

Question 37

How do you test tactile fremitus?

Answer 37

Patient says 99 while placing hands in chest symmetry test positions.

Question 38

Where do you measure chest expansion?

Answer 38

Axillary folds Xiphoid Midway between xiphoid and umbilicus

Question 39

How do you test Rubor of Dependency?

Answer 39

Patient in dependent position Observe vein quality, color, capillary refill, temperature Lay patient supine, elevate leg to 45 deg (30 sec) Note paleness in foot Sit patient back up and note color in foot Arterial insufficiency if - Takes 30 seconds to get back to normal color - Foot rebounds with deep rubor

Question 40

How do you test Venous filling time?

Answer 40

Positioning the same for Rubor of Dependency Choose a specific vein to observe Start in dependent  supine leg elevated  dependent Count with watch time it takes veins to reappear Normal time for veins to reappear: 10-15 sec

Question 41

How do you test Homan's sign?

Answer 41

Supine or long sitting Squeeze under gastroc and DF ball of foot Positive = pain Not best test; can be other causes of pain S/S: swelling, warmth, localized calf pain, redness