Lecture 4 DSA/CIS: Respiratory Exam

Question 1

Where would a needle thoracentesis take place?

Answer 1

2nd intercostal space superior to 3rd rib

-midclavicular line

Question 2

Where would chest tubes be inserted?

Answer 2

4th intercostal space superior to 5th rib

-mid or anterior axillary line

Question 3

Where would the lower margin of the endotracheal tube on a chest x-ray be found?

Answer 3

T4

Question 4

Where would a thoracentesis take place?

Answer 4

7th intercostal space

Question 5

What are important vital signs?

Answer 5

Respiratory Rate
Heart Rate
Blood Pressure
Temperature
Oxygen Saturation

Question 6

What is a normal respiratory rate?

Answer 6

14-20 breaths per minute

Normal = quiet, no distress

Question 7

What are causes of a bad waveform (which affects pulse ox reading)?

Answer 7

Improper placement
Hypoperfusion
Hypothermia
Motion artifact

Question 8

What does capnography measure?

What are the normal levels?

Answer 8

Ventilation (partial pressure of exhaled CO2 > EtCO2)
PETCO2 (exhaled CO2) = 35 - 40 mmHg
PaCO2 = 35 - 45 mmHg

Question 9

What are signs of hypoxia?

Answer 9

Cyanosis

-bluish discoloration of skin, lips, nails and mucus membranes

Question 10

What causes a traumatic flail chest?

What characterizes it?

Answer 10

Multiple rib fractures that may cause paradoxical movements of thorax
Injured area caves inward during inhalation and outward during exhalation

Question 11

Using accessory muscles for respiration can be a sign of respiratory distress. In what illnesses is this seen in?

Answer 11

Asthma
COPD
Airway obstruction
Viral illnesses

Question 12

What can cause stridor

Answer 12

Croup
Epiglottitis
Upper airway foreign body
Anaphylaxis

Question 13

What is atelectasis?

Answer 13

-collapse of alveolar lung tissue

Question 14

What are signs of atelectasis?

Answer 14

Shallow breathing or shortness of breath especially after surgery (since patients don’t wanna breathe in deep due to pain)
-diaphragmatic excursion elevated one side of the body

Question 15

What is an incentive spirometer?

Answer 15

Device that measures how deeply a person can inhale

-can treat atelectasis

Question 16

In what illnesses will there be abnormal bronchophony, whispered pectoriloquy, and egophony?

Answer 16

Lung consolidation

• tumor
• pneumonia
• effusion

Question 17

What is pulse oximetry?

Answer 17

Photodetector that detects ratio of red to infrared light to give the peripheral O2 sat (SPO2)

Question 18

What should you check for on inspection?

Answer 18

Sitting position, accessory muscle use, color, shape of nails, pursing, ability to speak
Any anatomical deformities in the chest

Question 19

What does tracheal deviation indicate?

Answer 19

Pneumothorax (tension and non tension)
Pleural effusion
Atelectasis
Mass

Question 20

COPD usually presents as ….

Emphysema usually presents as ….

Answer 20

Overweight and cyanotic, daily productive cough, elevated Hgb

Older and thin, quiet chest, hyperinflation of lungs with flat diaphragm

Question 21

What are the accessory muscles?

Answer 21

trapezius, scalenes, SCM

Question 22

How do you test for thoracic expansion?

Answer 22

Thumbs at 10th ribs level at lateral rib cage and have patient inhale
-check symmetry during inhalation

Question 23

OSE for the lungs?

OMT treatments for the lungs?

Answer 23

TART, and check T2-T7 (viscera level of the lungs)

Doming the diaphragm
Rib raising - SNS normalization
Tapotement
Thoracic pump - atelectasis

Question 24

Generalized hyperresonance suggests?

Unilateral hyperresonance suggests?

Answer 24

COPD, emphysema, asthma

Large pneumothorax, air filled lung (as in COPD or emphysema)

Question 25

What does asymmetric diaphragmatic excursion suggest?

Answer 25

• pleural effusion

- atelectasis or phrenic nerve paralysis (high diaphragm)

Question 26

What is the systemic approach to auscultation?

Answer 26

1. ) Listen for normal breath sounds
2. ) Listen for added/abnormal sounds
3. ) Listen for vocal resonance (muffled voice through stethoscope) if abnormalities exist

Question 27

What do pulmonary function tests like spirometry look for?

Answer 27

Obstructive or restrictive lung disease

Question 28

How do you systematically read an XRay?

Answer 28

A (PIER)
A irway
B ones
C ardiac size/valves
D iaphragm
E ffusion/Endotracheal tube
F ields and fissures
F oreign body
G reat vessels
G astic bubble
H ilar masses
I mpression