Final- Look Over Midterm

Question 1

Where do you perform a needle decompression?

Answer 1

2nd ICS just superior to 3rd ICS at the midclavicular line

Question 2

Where do you insert a chest tube?

Answer 2

4th ICS at mid axillary or anterior axillary line

Question 3

Where should the trachea be positioned? What is a cause of displacement?

Answer 3

Should be at midline

Lateral displacement due to tension pneumothorax

Question 4

What are some conditions in which fingernail clubbing occurs?

Answer 4

Heart disease, lung disease/cancer, cystic fibrosis

Question 5

What is tactile fremitus?

Answer 5

Palpable vibrations transmitted through bronchopulmonary tree to chest wall as someone speaks

Question 6

What are some causes of decreased tactile fremitus?

Answer 6

COPD, pleural effusion, pneumothorax

Question 7

What are some causes of increased tactile fremitus?

Answer 7

Pneumonia

Question 8

How do you percuss for lower respiratory exam?

Answer 8

Percuss in a ladder pattern from upper left down the back

Question 9

What does dullness replace resonance with percussion?

Answer 9

When fluid or soft tissue replaces air filled lungs

Causes- pneumonia or pleural accumulation of substances

Question 10

When will you hear hyperresonance with percussion of lower resp exam?

Answer 10

With COPD and asthma

Question 11

What is diaphragmatic excursion? What is a normal finding?

Answer 11

Finding the difference in the level of dullness during expiration and inspiration
SHould be 3-5 cm

Question 12

What are the 4 normal breathing sounds heart with auscultation?

Answer 12

Vesicular
Bronchovesicular
Bronchial
Tracheal

Question 13

Where do you hear vesicular breath sounds?

Answer 13

Heart with inspiration over most of the lungs

Question 14

Where do you hear bronchovesicular breath sounds?

Answer 14

Heard in inspiration and expiration in the 1st and 2nd ICS anteriorly

Question 15

Where do you hear bronchial breath sounds?

Answer 15

Heard during expiration over manubrium

Question 16

Where do you hear tracheal breath sounds?

Answer 16

Over the trachea

Question 17

What are some adventitious breath sounds?

Answer 17

Crackles/rales
Wheezes- associated with COPD and asthma
Rhonchi
Stridor- wheeze during inspiration, tracheal obstruction, treat ASAP

Question 18

What is bronchophony?

Answer 18

When listening to lungs have patient say 99

Will sound loud and clear

Question 19

What is egophony?

Answer 19

Have patient make EEE sound

Will sound less like EEE and more like AYYY

Question 20

What is whispered pectoriloquy?

Answer 20

Have patient whisper 99 and it will sound louder and clearer than expected

Question 21

What is the order for PE of lower resp?

Answer 21

Inspect, palpate, percuss, auscultate

Question 22

What are the 5 fingers of normal heart exam?

Answer 22

History, physical, ECG, x-ray, lab tests

Question 23

What are the 4 locations of auscultation for heart sounds?

Answer 23

Aortic Valve- 2nd ICS on R SB
Pulmonary Valve- 2nd ICS on L SB
Tricuspid Valve- 4th ICS on L SB
Mitral Valve- 5th ICS at L mid-clavicular line

Question 24

What are the 4 heart sounds?

Answer 24

S1- heard when AV valves close
S2- heart when SL valves close
S3- heart after rapid filling of atria due to rapid deceleration
S4- heart when atria contract against stiff ventricles

Question 25

How do you grade a murmur?

Answer 25

1-3- increasing vol WITHOUT THRILL 4-6- increasing vol WITH THRILL 6- can hear with stethoscope off chest

Question 26

When inspecting the chest are 3 abnormalities?

Answer 26

Pectus carinatum- pigeon chest Pectus excavatum- funnel chest Barrel chest- COPD increased A/P diameter

Question 27

How do you access point of maximal impulse?

Answer 27

Have patient left lateral recumbent | Palpate at left 4th ICS at midclavicular line just inferior to nipple

Question 28

How do you great peripheral pulses?

Answer 28

``` 0- absent 1- faint 2- normal 3- strong 4- bounding ```

Question 29

Where can you test for edema?

Answer 29

Anterior tibia Dorsum of foot Posterior to medial malleolus

Question 30

How do you grade edema?

Answer 30

``` 0- absent 1- barely detectable 2- 10-15 seconds 3- more than a minute 4- more than 2 minutes ```

Question 31

How do you measure JVP? What is considered normal? What is a common cause of elevated JVP?

Answer 31

Have patient lie supine to allow veins to enlarge, then raise to 45 degrees, measure from JV to suprasternal notch then add 5 Normal is 0-9 Elevated JVP is associated with elevated RV diastolic pressure

Question 32

What is the cause of the A wave of JVP?

Answer 32

Caused by RA contraction | Increased with stenosis, PE, and pulmonary hypertension

Question 33

What is the cause of the C wave of JVP?

Answer 33

Caused by AV valves closing which reflects pressure back into the jugular

Question 34

What is the V wave of JVP?

Answer 34

Represents passive atrial filling which increase atrial pressure which reflects into jugular vein