Mini Exam 3 (09/09)

Question 1

Identify the reference lines of the thorax -know the reference lines and be able to apply them to a clinical situation

Answer 1

Front view:
-Anterior Axillary Line 
-Midclavicular Line 
-Midsternal Line
Side View:
-Anterior Axillary Line 
-Midaxillary Line
-Posterior Axillary Line

Question 2

List the system-appropriate history questions for the lungs?

Answer 2

Cough?
Shortness of Breath?
Chest pain?
History of Respiratory Infections?
Smoking History?
Environmental Exposure? -toxic chemicals because of work etc

Question 3

Inspection of Thorax and Lungs

Answer 3

Shape and Configuration of chest wall

• spinus processes in a straight line (no scoliosis or kyphosis -humpback)
• symmetric: scapula and thorax
• A:T (anterior to transverse) 1:2-5:7 (barrel chest is 1:1)
• Costal Angle >90 degrees
• Ribs @45 degree slope
• accessory muscles

Question 4

Anterior Chest Shape and Configuration

Answer 4

• costal angle <90 degrees
• abdominal muscles
• facial expression-relaxed
• Level of Consciousness: alert, cooperative
• Quality of Respirations: effortless, regular
• No retraction or bulging of ICS
• breathing position: normal, not leaning or hunching
• Skin color and condition: warm and dry

Question 5

Palpation: Posterior Chest

Answer 5

• Symmetric Expansion: thumbs @T9, T10
• Tactile fermitus: have pt say “blue moon” or “99” (less vibration=obstruction; More vibration=compression or consolidation of lung tissue)
• Chest Wall: tenderness? Temp? Moisture? Lumps or Lesions?

Question 6

Palpation: Anterior Chest

Answer 6

• Symmetric: chest expansion: thumbs along costal margins, pointing downwards towards xiphoid process (asymmetric can mean a pneumothorax)
• Tactile fermitus: side to side and avoid breast tissue
• Chest Wall: access turgor infraclavicular
• Tenderness? Lumps? Temp? Moisture?
• Creptius (coarse crackling) can be felt around a fractured clavical

Question 7

Percussion: Anterior Chest

Answer 7

Lung fields: 
-side to side comparison
-avoid scapulae and ribs 
-apex @ C7 to 2-4 cm above clavicles
-bass lies on diaphragm 
Resonance:
-Hyperresonance: too much air; low pitch 
-Hyporesonance: abnormal density

Question 8

Auscultation: Posterior Chest

Answer 8

Breath sounds: diaphragm, one full respiration
-Bronchial: (trachea, larynx) short inhale long exhale
-Bronchovascular: (bronchi) equal inhale and exhale
-Vescular (peripheral lung fields) long inhale short exhale
Voice sounds: soft, muffled, indistinct

Question 9

Auscultation: Anterior Chest

Answer 9

Side to side - one full breath 
Breath sounds: avoid breast tissue 
-vesicular 
-bronchovesicular
-bronchial
Pulmonary fracture status: 
-Pulse Oximetry >90%

Question 10

Describe expected lung sounds

Answer 10

Bronchial: high pitch, loud, harsh hollow tubular sound
Bronchovesicular: moderate pitch, moderate volume, mixed quality
Vesicular: low pitch, soft volume, rustling sounds

Question 11

Adventitious Sounds

Answer 11

• Crackles: discrete, popping sounds
• Wheezes: connected musical sounds
• Stidor: high pitched, monophonic inspiratiory crowing sounds. Louder in neck, originates in larynx or trachea (swollen tissues or foreign body)

Question 12

Discuss the developmental changes in the lungs of the aging adult

Answer 12

• thorax less mobile
• chest expansion decreased
• increased A:T diameter
• Kyphosis: outward curvature of the thoracic spine
• Decreased lung capacity
• easily fatigued