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PCM1 Final Exam > Lower Respiratory > Flashcards

Lower Respiratory Flashcards

1
Q

What are the 4 steps of a lower respiratory exam?

A

inspection, palpation, percussion, and auscultation

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2
Q

What is the sternal angle? What is another name for it?

A

angle of Louis -> where the 2nd ribs join the sternum

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3
Q

Where would you perform a needle thoracentesis (decompression)?

A

2nd intercostal space, midclavicular line

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4
Q

Where would you insert a chest tube?

A

4th and 5th intercostal space just anterior to mid-axillary line

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5
Q

Should chest tubes and needles be placed over or under ribs?

A

along superior margin (over) ribs; neuromuscular bundle runs along inferior margin of each rib

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6
Q

What is atelectasis? What can help prevent it?

A

loss of lung volume due to collapse of lung tissue (alveoli); seen post-surgery; Incentive spirometer (IS) can help prevent it

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7
Q

What is accessory muscle use? What muscles are used in accessory muscle use?

A

sign of respiratory distress;

Scalenes, SCM, and supraclavicular retrations

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8
Q

What is cyanosis?

A

blue skin (either in nail bed or perioral); sign of hypoxia

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9
Q

What may cause tracheal deviation?

A

pneumothorax, pleural effusion, atelectasis, or mass

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10
Q

What are some of the causes of clubbing?

A

congenital heart disease, interstitial lung disease, pulmonary fibrosis, cystic fibrosis, lung abscess, lung acne, or inflammatory bowel disease (IBD)

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11
Q

Describe pectus excavatum

A

funnel chest; depression in lower portion of sternum; can compress heart and great vessels causing murmurs

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12
Q

Describe pectus carinatum

A

pigeon chest; sternum anteriorly displaced w/ adjacent costal cartilages depressed

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13
Q

Describe barrel chest

A

increased AP diameter resembling a barrel; seen in COPD

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14
Q

Describe a blue bloater

A

chronic bronchitis (daily productive cough for 3 months or more for 2 consecutive years); overweight/cyanotic, peripheral edema, rhonchi and wheezing

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15
Q

Describe a pink puffer

A

emphysema; older/thin w/ severe dyspnea; X-ray will show hyperinflation w/ flattened diaphragm

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16
Q

Describe a flail chest

A

multiple rib fx may result in paradoxical movement of thorax

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17
Q

How do you examine thoracic expansion?

A

place thumbs at 10th ribs posteriorly w/ fingers loosely grasping rib cage; ask pt to inhale deeply and feel for symmetry of rib cage

18
Q

What is tactile fremitus? What causes increased/decreased fremitus?

A

palpable vibrations on pt’s back as they speak
Increased: consolidation (pneumonia)
Decreased: COPD or pleural changes

19
Q

Name 5 percussion sounds and their normal locations?

A 
flat - thigh
dull - liver
resonant - healthy lung
hyperresonant - none
tympanitic - gastric air bubble or puffed-out cheek
20
Q

Causes of dullness when percussing lungs

A

fluid or solid tissue replaces air-containing lung

21
Q

Causes of hyper resonance when percussing lungs

A

heard over hyper inflated lungs (COPD; emphysema; asthma)

22
Q

What does unilateral hyper resonance suggest when percussing lungs?

A

pneumothorax or large air-filled bulla in lung (COPD/emphysema)

23
Q

What is suggested by asymmetrical diaphragmatic excursion?

A

pleural effusion or high diaphragm secondary to atelectasis or phrenic nerve paralysis

24
Q

How may spots should you listen to when auscultating lungs? How should the pt breathe?

A

2 on the front; 4 on the back; pt should breath through an open mouth

25
Q

What is stridor? Common causes?

A

high pitched inspiratory wheeze due to narrowing of upper airway; caused by croup, epilottitis, upper airway FB, or anaphylaxis

26
Q

What is wheezing? Common causes?

A

generally expiratory sound (continuous musical sound) due to rapid airflow through narrowed bronchial airway; caused by RAD, asthma, and COPD

27
Q

What is crackles (rales)?

A

inspiratory sound that sounds like “velcro”; discontinuous, intermittent and nonmusical; caused by pneumonia, CHF, atelectasis, COPD, and asthma

28
Q

Describe bronchophony

A

pt’s spoken words get louder when listening through stethoscope

29
Q

Describe whispered pectoriliquy

A

whispered words are louder and clear during ascultation

30
Q

Describe egophony

A

when pt says “ee” it sounds like “A”

31
Q

What does positive bronchophony, egophony, or whispered pectoriliquy usually mean?

A

lung consolidation (tumor, pneumonia, effusions)

32
Q

What does the following mnemonic for interpreting chest X-rays mean: AABCDEFFGGHI

A 
Assessment of quality
Airway
Bones
Cardiac size
Diaphragms
Effusions
Fields and fishes
Foreign body
Great vessels
Gastric bubble
Hilar masses
Impression
33
Q

What is the lower margin of an endotracheal tube on an Xray?

A

T4

34
Q

What is the landmark for a thoracentesis?

A

7th intercostal space

35
Q

Describe vesicular breath sounds

A

heard over most of lungs -> soft and low pitched (inspiration and 1/3 expiration)

36
Q

Describe bronchovesicular breath sounds

A

heard best in 1st and 2nd interspaces anteriorly between scapula; intermediate in intensity and pitch (equal in inspiration and expiration)

37
Q

Describe bronchial breath sounds

A

heard best over manubrium; loud and high pitched (expiratory longer than inspiratory)

38
Q

Describe tracheal breath sounds

A

best heard over trachea in neck; very loud and high pitched (equal during inspiration and expiration)

39
Q

Describe rhonchi

A

relatively low-pitched snoring sound that suggests secretions in airway

40
Q

Describe pleural friction rub

A

inflamed pleural surfaces grate against each other; sounds like “creaking” during expiration (can also occur during inspiration)

PCM1 Final Exam (10 decks)

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