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Flashcards in Lower Respiratory OSCE Deck (30)
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1

Anatomical landmarks during inspection of the chest

Sternal angle - where second rib meets with manubrium and sternal body

Suprasternal notch

Xiphoid process

Scapula

Thoracic vertebrae

2

Landmarks for needle decompression

2nd intercostal space just superior to the 3rd rib margin at the midclavicular line for emergent decompression tension pneumothorax, followed by chest tube placement

3

Landmarks for chest tube insertion

4th intercostal space at mid or anterior axillary line in the 4th intercostal space just superior to the margin of the 5th rib

4

T___ = lower margin of endotracheal tube on CXR

4

5

Landmark for thoracentesis

7th intercostal space

6

Normal respiratory rate

14-20x/min

7

Pursed lips while breathing is indicative of what condition

COPD

8

Why would you inspect the neck during respiratory exam?

Contraction of accessory muscles (SCM, scalenes, or supraclavicular retraction)

Tracheal position - should be midline (lateral displacement could occur in tension pneumothorax)

9

Signs of fingernail clubbing

Bulbous swelling of soft tissue at nail base; loss of normal angle between nail and proximal nail fold (>180 degrees) leading to spongy floating feeling

10

In what conditions might you see nail clubbing?

Congenital heart disease

Bronchiectasis

Pulmonary fibrosis

Lung abscess

INFLAMMATORY BOWEL DISEASE

Malignancies (lung cancer)

Cystic fibrosis

11

Techniques for palpation of the chest

Rib motion assessment

Thoracic expansion assessment

Tactile fremitus

12

When performing percussion in a respiratory exam, dullness replaces resonance when fluid or solid tissue replaces air containing lung or occupies space between percussing fingers. What conditions might this indicate?

Lobar pneumonia (alveoli filled with fluid and blood cells)

Pleural accumulation (effusion, hemothorax, empyemia (pus), fibrous tissue or tumor)

13

Generalied hyperresonance in percussing the lungs may be indicative of what conditions

COPD, emphysema, asthma

14

Unilateral hyperresonance while percussing the lungs may indicate what conditions

Large pneumothorax, large air-filled bulla in lung

15

Diaphragmatic excursion test

What is normal excursion?

Determine the distance between the level of dullness on full expiration and level of dullness on full inspiration by progressive percussion down from resonance (lung parenchyma) to dullness (structures below diaphragm)


Normal excursion = 3-5.5 cm

16

Which lung sounds are described below:

Soft and low pitched; heard through inspiration and about 1/3 of expiration, heard over most of lungs (parenchyma)

Vesicular

17

Which lung sounds are described below:

Intermediate in intensity and pitch; heard equally in inspiration and expiration, heard best in 1st and 2nd interspaces anteriorly and between the scapulae

Bronchovesicular

18

Which lung sounds are described below:

Loud and high pitched, expiratory sounds heard longer than inspiratory, heard best over manubrium (larger proximal airways)

Bronchial

19

Which lung sounds are described below:

Very loud and high pitched, heard equally in inspiration and expiration, heard best in the neck

Tracheal

20

What would you conclude if bronchovesicular or bronchial breath sounds are heard more distal to expected locations?

Air-filled lung has been replaced by fluid filled or solid lung tissue

21

Which lung sounds are described below:

Discontinuous, intermittent, nonmusical, brief

Defined as fine, course, or by timing in respiratory cycle

Crackles (rales)

22

Which lung sounds are described below:

Continuous musical quality and prolonged, relatively high pitched, suggestive of narrow airways like in asthma, COPD, and bronchitis

Wheezes

23

Which lung sounds are described below:

Relatively low pitched, snoring quality, suggestive of secretions in large airways

Rhonchi

24

Which lung sounds are described below:

Wheeze that is entirely or predominantly inspiratory in nature, often louder in neck vs chest wall

Stridor

25

What is stridor indicative of

Partial obstruction of larynx or trachea (immediate attention needed)

26

Which lung sounds are described below:

Creaking, usually during expiration but can occur in either, usually confined to relatively small area of chest wall

Pleural friction rub

27

____________ = spoken words become louder and clearer

Bronchophony

28

_________ ________ = whispers are heard louder and clearer during auscultation

Whispered pectoriloquy

29

_________ = "ee" sounds like "A"

Egophony

30

In patients with fever and cough, the presence of bronchial breath sounds and egophony more than triples the likelihood of ________

Pneumonia