Pulmonary

Question 1

Inspection Elements

Answer 1

Chest wall:  any deformities?
Symmetric expansion	
AP diameter of the chest is typically < lateral chest diameter
0.70 to 0.75 average for healthy adult
AP diameter increases with age
Kyphosis
Lordosis
Scoliosis
Barrel chest
Lips and fingernails

Question 2

AP diameter of the chest is typically

Answer 2

lateral chest diameter

0.70 to 0.75 average for healthy adult

Question 3

AP diameter increases

Answer 3

with age
Kyphosis
Lordosis
Scoliosis
Barrel chest

Question 4

Resp Rate Elements

Answer 4

Respiratory effort
Any retraction of muscles
Do you hear any sounds?  
Stridor
Wheeze
Dyspnea
Tachypnea
Bradypnea
Orthopnea

Question 5

Cough

Answer 5

Onset
Sputum production or dry cough
characteristics
Frequency
Severity
Associated symptoms
What have they tried
Sputum

Question 6

SOB

Answer 6

Onset
Pattern
Severity 
Associated symptoms
What have they tried

Question 7

Chest pain

Answer 7

Onset and duration
Associated symptoms
What have they tried

Question 8

Palpate thoracic muscles

Answer 8

Tenderness
Depressions
Masses
Bulges
Crepitus
Crackly sensation
Air in subcutaneous tissue
Palpated and heard

Question 9

Thoracic Expansion place thumbs along the

Answer 9

thumbs along the spinal processes at the level of the 10th rib

Question 10

Tactile fremitus

Answer 10

Palpable vibration
Heard best at the level of bifurcation of the bronchi
Ask patient to recite “99” or “Mickey Mouse”
Compare sides-do both sides feel similar?
Increased fremitus with fluid or a mass
Decreased fremitus with decreased lung tissue density
COPD
Asthma

Question 11

Percussion two techniques

Answer 11

direct and indirect

Question 12

Percussion - Resonance is

Answer 12

normal

Question 13

Percussion - Hyper resoance indictes

Answer 13

hyper inflation

COPD

Question 14

Percussion - Dullness noted with decreased air exchanges indicates

Answer 14

Pneumonia
Atelectasis
pleural effusion

Question 15

Measuring Diaphragmatic Excursion

Answer 15

Typically 3 to 5 cm
May be decreased in pulmonary or abdominal diseases
Percuss along the scapular line

Question 16

Auscultation

Answer 16

Patient in upright position
Compare right lung to left lung
Start at Apex then proceed to base
Listen for 
Intensity
Pitch
Quality
Duration
Use diaphragm of stethoscope
High pitched sounds

Question 17

Vesicular

Answer 17

Heard over most lung fields

Low pitched, low intensity

Question 18

Bronchovesicular

Answer 18

Heard over the bronchi

Moderate pitch, moderate intensity

Question 19

Bronchial

Answer 19

Heard over the trachea

High pitched

Question 20

Crackles

Answer 20

Heard more often during inspiration

Does not clear with a cough

Question 21

Rhonchi

Answer 21

Loud, low, coarse sound caused by thick secretions, muscular spasm, tumor, external pressure
May clear with a cough

Question 22

Wheeze

Answer 22

High pitched musical sound heard during inspiration or expiration

Question 23

Pleural effusion rub

Answer 23

Grating sound caused by inflammation of pleural spaces

Question 24

Pleural friction rub

Answer 24

Inflammation of the pleural spaces
Heard on inspiration and expiration
Disappears while holding your breath

Question 25

Pericardial friction rub

Answer 25

Inflammation of the pericardium Louder on inspiration Does not disappear while holding your breath

Question 26

Bronchophony

Answer 26

Recite numbers, names, words 99 or Mickey Mouse Increased clarity and loudness of spoken words Occurs with solid mass or lung consolidation with pneumonia

Question 27

Egophony

Answer 27

"E” changes to “Aaay” Occurs with lung consolidation Pneumonia Fibrosis

Question 28

Respiratory Abnormalities

Answer 28

``` Atelectasis Bronchitis Pleural effusion Asthma Pneumonia Pleurisy ```

Question 29

Infant A/P diameter

Answer 29

approximately the same as lateral diameter | RR 40-60/min

Question 30

``` School aged (6-12 years) RR ```

Answer 30

RR 18-30/min

Question 31

Pregnant Patients

Answer 31

Dyspnea is common Breathing is deeper but not more frequent Asthma could be affected during pregnancy

Question 32

Elderly Patients

Answer 32

``` Chest expansion may be decreased Calcification of ribs Patients may be less able to use respiratory muscles due to muscle weakness general physical disability sedentary lifestyle Bony prominences are marked Less subcutaneous tissue Kyphosis Doral curve of the thoracic spine ```

Question 33

RML heard best between

Answer 33

the right midaxillary line to the right axillary line on the anterior portion of the chest

Question 34

Right bronchus is

Answer 34

wider, shorter, and more vertically placed than left bronchus More susceptible to aspiration of foreign objects

Question 35

Diaphragm on the right chest may be

Answer 35

higher than the left chest due to the size and position of the liver Always compare right to left

Question 36

ROS

Answer 36

Denies cough, sputum production, shortness of breath

Question 37

PE

Answer 37

Respiratory rate regular with ease of chest expansion. Breath sounds clear to auscultation bilaterally without wheezes, rhonchi or crackles. AP diameter less than lateral diameter. Lung percussion resonant in all lung fields bilaterally. Thoracic expansion symmetric. Diaphragmatic excursion 3 cm bilaterally. RR documented under VS

Question 38

Kyphosis

Answer 38

Outward curvature of the back. Elderly women

Question 39

Lordosis

Answer 39

Sway back. Inward arch

Question 40

Scoliosis

Answer 40

Sideward curve

Question 41

Barrel Chest

Answer 41

round bulging chest

Question 42

Decreased fremitus could indicate

Answer 42

air or fluid in the pleural space or COPD or asthma

Question 43

Dullness to percussion indicates

Answer 43

denser tissue Consolidation with pneumonia solid mass tumor pleural effusion

Question 44

Most common lung condition found in surgery

Answer 44

atelectasis

Question 45

pleurisy

Answer 45

inflmaiton of pleural spaces