Exam 2

Question 1

What is a Normal Adult Chest? Draw

Answer 1

Symmetrical

Question 2

What is a Funnel Chest? Draw

Answer 2

Breastbone sinks into the chest

Question 3

What is Pectus Excavatum?

Answer 3

Congenital chest wall deformity caused by growth abnormality of the cartilage that connects the ribs to the breastbone (Sternum). Sunken in or funnel chest appearance. More common in boys.

Question 4

What is Barrel Chest? Draw

Answer 4

Anterior and posterior are the same width as the left and right. Round like a barrel due to lungs being chronically OVER inflated with air (associated with COPD or Emphysema; CO2 is unable to escape).

Question 5

What is Pigeon Chest (Pectus Carinatum)? Draw.

Answer 5

Non-Life threatening condition. Marked by an abnormally outward protruding breastbone.
Cause: Rapid cartilage growth forcing the front o the chest cavity outward.

Question 6

What is Traumatic Flail Chest? Draw.

When does it occur?

Answer 6

2 or more contiguous rib fractures with 2 or more breaks per rib. Serious. Associated with morbidity and mortality.

Occurs when a portion of the chest wall is destabilized. Typically from blunt force trauma.

Question 7

What is Thoracic Kyphoscoliosis? Draw. (Hint: Zombie Walk)

What causes this?

Answer 7

Abnormal curve of the spine on two planes: Coronal (side to side) and Sagittal (back to front)

No known cause but can be the result of: Prolonged bad posture, Osteochondrodysplasia, Degenerative Disease(s), Neuromuscular Disease(s), Connective Tissue Disease(s), & TB

Question 8

What are the abnormal s/s in patients (pt) with Dyspnea/Respiratory Distress?

Answer 8

Trouble Breathing
Use of accessory muscles (Sternocleidomastoids & Scalenes)
Asthma (Bronchial Hyper-responsiveness & Broncho-constriction)
Pneumonia
Spontaneous Pneumothorax
Acute Pulmonary Embolism (sudden onset with Tachypnea)
Chronic Bronchitis
COPD
Left sided heart failure
Hyper ventilation

Question 9

What is the primary subjective data process in order to assess a pt with complains of chest discomfort?

Answer 9

OLDCART

Question 10

What does OLDCART stand for?

Answer 10

Onset
Location
Duration
Characteristics of Symptoms
Associated Manifestations
Treatment

Question 11

What is Tactile Fremitus?

Answer 11

Vibration of the chest wall

Question 12

How do you assess Tactile Fremitus?

Answer 12

Compare both sides of the chest, using the ball or ulnar surface of your hand.

Fremitus is usually decreased or absent over the precordium when examining a woman (displace breasts if needed)

Ask the patient to repeat the words “ninety-nine” or “one-on-one”.

Question 13

What does an increase transmission of voice sounds suggest?

Answer 13

An air-filled lung has become airless.

Increase in tactile fremitus indicates denser or inflamed lung tissue

Question 14

Characteristics of Breath Sounds: Vesicular

Answer 14

Duration: Inspiratory sounds last longer than expiratory sounds
Intensity of Expiratory Sound: Soft
Pitch of Expiratory Sound: Relatively Low
Locations where heard normally: Over most of both lungs

Question 15

Breath Sounds: Bronchovesicular

Answer 15

Duration: Inspiratory and expiratory sounds are about equal
Intensity: Intermediate
Pitch: Intermediate
Locations to hear: Often in the 1st and 2nd intercostal spaces anteriorly and between the scapulae

Question 16

Breath sounds: Bronchial

Answer 16

Duration: Expiratory lasts longer than inspiratory
Intensity: Loud
Pitch: Relatively High
Locations to hear: Over the manubrium if heard at all

Question 17

Breath Sounds: Tracheal

Answer 17

Duration: Inspiratory and expiratory sounds are about equal
Intensity: Very Loud
Pitch: Relatively high
Location to hear: Over the trachea in the neck

Question 18

Abnormal Breath Sounds: Non-Continuous. What does it sound like?

Answer 18

Crackles (or rales)
Intermittent, nonmusical, and brief
Like dots in time
Fine crackles (soft, high pitched, very brief) 5-10 msec
Coarse Crackles (louder, lower in pitch, brief) 20-30 msec

Question 19

Abnormal breathing sounds: Continuous. What does it sound like?

Answer 19

Wheezes and Rhonchi
Greater or equal to 250 msec. Sinusoidal prolonged
Like dashes in time
Wheezes = musical, relatively high pitched with hissing or shrill more than or equal to 400 hz
Rhonchi = low pitched with snoring quality less than 200 hz

Question 20

Factors that aggravate asthma and associated symptoms. What is the process?

Answer 20

Bronchial hyper responsiveness involving release of inflammatory mediators, increased airway secretions and bronchoconstriction

Question 21

What is the Timing?

Answer 21

Acute episodes, separated by symptom-free periods, nocturnal episodes are common

Question 22

What are the aggregating factors?

Answer 22

Allergies, Pollen, Chemicals, Mold, Pollution, Sinus Infections, Acid Reflux, Bad Weather, Physical exercise

Question 23

What are the symptoms of Asthma?

Answer 23

Wheezes on exhalation, Dyspnea (SOB), Tachypnea, Chest pain, Frequent coughing/wheezing, Fatigue, Low peak flow meter reading.

Question 24

Percussion Notes: Flatness

Answer 24

Intensity: Soft
Pitch: High
Duration: Short
Location: Thigh
Pathologic ex: Large pleural effusion

Question 25

Percussion sounds: Dullness

Answer 25

``` Intensity: Medium Pitch: Medium Duration: Medium Location: Liver Pathologic Ex.: Lobar Pneumonia ```

Question 26

Percussion Sounds: Resonance

Answer 26

``` Intensity: Loud Relative Pitch: Low Relative Duration: Long Location: Healthy lung Pathologic Ex.: Simple chronic bronchitis ```

Question 27

Percussion: Hyperresonance

Answer 27

``` Intensity: Very loud Pitch: Lower Duration: Longer Location: N/a Pathologic Ex.: COPD, Pneumothorax ```

Question 28

Percussion: Tympany

Answer 28

``` Intensity: Loud Pitch: High Duration: Longer Location: Gastric air bubble or puffed out cheek Patho Ex.: Large pneumothorax ```

Question 29

What is the order of the Lung Lobes?

Answer 29

``` RUL = Right Upper Lobe RML = Right Middle Lobe RLL = Right Lower Lobe ``` ``` LUL = Left Upper Lobe LLL = Left Lower Lobe ```

Question 30

What are the sources of chest pain? : Pulmonary

Answer 30

``` Bronchitis = trachea and large bronchi Pneumonia = parietal pleura ```

Question 31

Source Chest Pain: Cardiac

Answer 31

Pericarditis = Pericardium (around heart) Angina Pectoris = Myocardium Myocardial Infarction = Myocardium Dissecting Aortic Aneurysm = Aorta

Question 32

Sources of Chest Pain: Epigastric

Answer 32

Reflux Esophagitis = Esophagus Esophageal Spasm = Esophagus Gastritis = Stomach Biliary Colic = Gallbladder

Question 33

What is the proper use of a Rescue Inhaler?

Answer 33

Blow all your air out Start creating a vacuum with your diaphragm Just as breathing in = pop rescue inhaler Hold it in as long as possible then exhale

Question 34

Rinne Test: How to determine Conductive Loss?

Answer 34

Turning fork at external auditory meatus then on mastoid bone Air Conduction = vertical when turning fork Bone Conduction = Horizontal turning fork BC greater than AC

Question 35

Rinne Test: How to determine Sensorineural Loss?

Answer 35

Turning fork at external auditory meatus then on mastoid bone Air conduction: vertical turning fork Bone Conduction: horizontal turning fork AC greater than BC (Normal finding)

Question 36

Weber Test: What comes with conductive loss?

Answer 36

Sound lateralizes toward the affected ear

Question 37

What comes with unilateral sensorineural loss?

Answer 37

Sound lateralizes to the normal or better-hearing side

Question 38

Weber Test: What is the difference between Conductive and Sensorineural Loss?

Answer 38

Conductive Turning fork @ Vertex Sound lateralizes to impaired ear = room noise not well heard, detection of vibration improves Sensorineural Turning fork at Vertex Sound lateralizes to good ear = inner ear or cochlear nerve damage impaired transmission to affected ear

Question 39

What are the visual characteristics of a normal eardrum?

Answer 39

Tympanic membrane is pinkish gray Malleus lies behind the upper part of the ear drum Above the short process lies the pars flaccida Remainder of the drum is the pars tensa From the umbo, the bright cone of light fans anteriorly and downward Posterior to the malleus, part of the incus is visible behind the drum The small blood vessels along the handle of the malleus are normal

Question 40

What does an Abnormal Eardrum look like?

Answer 40

Opaque, erythema, bulging, discharge from ruptured eardrum (no perforation)

Question 41

What are the S/S of inner ear problems?

Answer 41

``` Earache = pain in the ear Discharge = associated with trauma or ear-ache Tinnitus = perceived sound that has no external stimulus and commonly heard as musical ringing, buzzing or a rushing or roaring noise Vertigo = perception that the room in spinning or rotating (middle or inner ear problem) ```

Question 42

How do you palpate paranasal sinuses?

Answer 42

Palpate with your thumbs Frontal = Above orbit Maxillary sinus = below orbit

Question 43

Which cranial nerve is associated with the inability to move the tongue

Answer 43

Hypoglossal nerve (CN XII) Ctrl. Muscles of the tongue Cranial nerves 11 & 12